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1
C6e Llfjtarp
of t^e
DltJi0fon of pzaitb affairs
canltjergitp of mom Carolina
)
This Book Must Not Be Taken
from the Division of Health
Affairs Buildings.
ThU JOURNAL may be kept out TWO DAYS,
and is subject to a fine of FIVE CENTS a day
thereafter. It is DUE on the DAY indicated
below:
'wN^^^^B*(P*rfiiB£^
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lar-fr
DR. v; R. BERRYHILL,
CHAPEL HILL. N. C.
I TKb BuUetm will be sehi free to anil citizen of ri\e Siate upon request i
Published monthly at the office of the Secretaiy of the Board, Raleigh, N. C
Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912
Vol. 69 JANUARY, 1954 No. 1
j^
CURRITUCK COUNTY HEALTH CENTER
CURRITUCK, NORTH CAROLINA
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
G. G. Dixon, M.D., President Ayden
Hubert B. Haywood, M.D., Vice-President Raleigh
H. Lee Large, M.D Rocky Mount
John R. Bender, M.D Winston-Salem
Ben J. Lawrence, M.D Raleigh
A. C. Current, D.D.S Gastonia
H. C. Lutz, Ph.G Hickory
Geo. Curtis Crump, M.D Asheville
Mrs. J. E. Latta HUlsboro, Rt. 1
EXECUTIVE STAFF
J. W. R. Norton. M.D.. M.P.H., State Health Officer
John H. Hamilton, M.D., Assistant State Health Officer and Director
State Laboratory of Hygiene
C C. Applewhite. M.D., Director Local Health Division
Ernest A. Branch, D.D.S., Director of Oral Hygiene Division
A H. EUiot, M.D.. Director Personal Health Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
Fred T. Foard, M.D., Director Epidemiology Division
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin, which will
be sent free to any citizen requesting it. The Board also has available for
distribution without charge special literature on the foUowmg subjects. Ask
for any in which you may be Interested.
Diphtheria Measles Residential Sewage
Flies Scarlet Fever Disposal Plants
Hookworm Disease Teeth Sanitary Privies
Infantile Paralysis Typhoid Fever Water Supplies
Influenza Typhus Fever Whoopmg Cough
Malaria Venereal Diseases
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent free to
any citizen of the State on request to the State Board of Health, Raleigh. N. C.
Prenatal Care Five and Six Months
Prenatal Letters (series of nine) Seven and Eight Months
monthly letters) Nme Months to One Year
The Expectant Mother One to Two Years
Infant Care ^^° ^° Six Years
The Prevention of InfantUe Diarrhea Instructions for North Carolina
Breast Feeding Midwives
Tahlp of Heiehts and Weights Your Child From One to Six
Bibv's Daily Iched^e ^ Your Child From Six to Twelve
First Four "Months Guidmg the Adolescent
CONTENTS Page
Public Health And The Private Physician 3
Fluoridation Of Public Water Supplies 8
Legal Problems Of Public Health 10
Notes And Comment 1^
w hmBm IPUBLI5MED BYTAE N^RTM CAROLINA STATE B*ARD«/AEALTA
Vol. 69 JANUARY, 1954 No. 1
}. W. R NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor
PUBLIC HEALTH AND THE PRIVATE
PHYSICIAN**
Obligations and Opportunities
JOHN R. BENDER, M.D.***
Winston-Salem, N. C.
As a member of the Board of Health
of Forsyth County and also of the State
Health Department, I have been aware
of the caustic remarks and unjust criti-cism
by laymen and professional col-leagues
alike, who, out of selfishness or
misunderstanding, have expressed the
backward views of short-sighted per-sonalities
rather than the long-range
vision of mature judgment. There are
few physicians in private practice who
are not alert to the need for improve-ment
in the treatment of individual
illness or injury, but entirely too many
overlook their opportunity for leader-ship
in planning efficient local health
centers, hospitals, and medical services
for their communities. When we physi-cians
fail to participate in community
health planning, we are neglecting our
civic duty; and those who assume this
responsibility as the result of our de-fault
may omit medical consultation
altogether when they undertake a pro-gram
of medical care. Inertia on the
part of physicians with respect to their
Reprinted from the North Carolina
Medical Journal.
**Read before the First General Session,
Medical Society of the State of North Caro-lina,
Pinehurst, May 12, 1953.
***Chairman of the Board of Health,
Forsyth County, North Carolina.
community responsibilities antagonizes
the public. The answer "too busy" to
attend the sick or to serve on boards,
health councils, and agencies becomes
a mockery when these "busy" physi-cians
are seen two or three afternoons
a week on the golf links. In order to
avoid indictment of our profession,
physicians must strive to maintain
good will in our respective communities
through a willingness to serve.
Definition and Objectives
The interrelationship between the lo-cal
health department, the practicing
physician, and the community can be
better understood if we analyze the
defintion of public health. The defini-tion
accepted by the United Nations
reads:
"Public Health is the art and science
of preventing disease, prolonging life
and promoting physical health and effi-ciency
through organized community
effort for the sanitation of the environ-ment,
the control of communicable in-fections,
the education of the individual
in principles of personal and com-mimity
health, the organization of
medicine and nursing services for the
early diagnosis and preventive treat-
The Health Bulletin January, 1954
ment of disease and for the develop-ment
of the social machinery which
will insure to every individual in the
commimity a standard of living ade-quate
for the maintenance of health."
Therefore, public health should be
considered an institution created by
society to protect and promote a state
of community well-being. We may also
accept the premise that through public
health each community should so or-ganize
its efforts as to enable every
citizen to realize his birthright of
health and longevity. It is in his local
commimity that the physician has his
greatest opportunity to become a states-man
in public health.
We must recognize the continuous
interacting relationship between the
practice of medicine and the social and
economic pattern of the community. It.
is here that many of our public health
problems exist. These social and eco-nomical
patterns create different prob-lems
in different commimities and
necessitate the many different divisions
in the structure of health administra-tion.
Regardless of diversified com-munity
problems, however, none of the
special divisions of health service
should enter fields which will create
friction in the structure of medical
care.
The object of public health is not
merely to prolong life, but to increase
the vigor, efficiency, and happiness of
all the members of our complex society.
This is no easy goal, and it has no ap-peal
for those who fear opposition or
criticism. Just as the function of the
practitioner is to cure for the individual
sick person, the fimction of public
health is to prevent illness in the com-munity.
Health oflBcers and private
practitioners realize that their duties
are the same—namely, the care of the
sick and the prevention of disease.
The basic principles of the American
Medical Association are: "To promote
the science and art of medicine and
the betterment of 'Public Health'." The
principal objectives of the U. S. Public
Health Service, the State Board of
Health, and the local health depart-ment
are the same. This unity of
thought and oneness of purpose has
created an endorsement, one for the
other. There is no conflict between
these agencies and private medicine.
It should be remembered that public
health is not limited to preventive med-icine,
communicable disease control,
santiation, or anything less than the
promotion and attainment of better
community health. To attain this goal,
we must use our vast knowledge and
skill for the prevention of disease. The
commimity must rely upon its local
health department for the diagnosis
and treatment of its various ills. A few
community problems which come under
the specialized care of the community
doctor—the board of health—are en-virormiental
sanitation, rodent control,
sewage disposal, stream pollution, pas-teurization
of milk, inspection of food,
maternal welfare, accident prevention,
and many others. Each of these prob-lems
is directly concerned with the pre-vention
of disease and the betterment
of the community. The task requires
the full utilization of all available pro-fessional
knowledge and skill; and, far
from giving rise to conflict, should
create the closest unity between the
local health department and the pri-vate
practitioner.
The Health Department
—
Administration
The health of any community with
a local health department rests upon a
tripod—namely, the health department,
the practicing physician, and the pri-vate
citizen. The health department,
under the local health ofBcer, is the
administrator of such community assets
as federal and state funds, grants, gifts,
fees, taxes, appropriations, and so forth.
This supportive leg of the tripod, which
I choose to speak of as administrative,
is closely associated with the various
communities of the county health dis-tricts,
and the health officer acts as
liason between the individual citizen
and his county board of health, the
State Board of Health, the federal
government, and the U. S. Public
Health Service. This administrative leg
was created by legislative action, first
January, 1954 The Health Bulletin
in the establishment of a State Board
of Health and later in the establish-ment
of local boards.
Power delegated to the local boards
of health through constitutional and
statutory authority gives the health
department of each county or health
district local autonomy. The authoriza-tion
reads:
"The County Board of Health shall
have the immediate care and respon-sibility
of the Health interest of their
County. They shall make such rules
and regulations and impose such pen-alties
as in their judgment may be
necessary to protect and advance the
public health."
This sweeping grant of power to legis-late
in health matters gives the local
health department autonomy which is
respected by the courts so long as it
does not run counter to state and
federal constitutions and statutes. With
this delegated power goes the respon-sibility
of each physician in the com-munity
to analyze local situations as
they arise. Where conflicts or friction
exist they should be met with an
honest, courageous, objective approach,
with a sharing of responsibilities and a
mutual confession of errors. The
achievement of our purpose—to protect
and advance the public health—does
not require all sweetness and deference,
for such an attitude or purpose would
be worse than no purpose at all. Only
in honest disagreement, provided it
does not reach the point of stifling the
effectiveness of the health department,
will the department grow, develop and
move forward.
The Private Physician—Construction
This bring us to the second support
of the tripod, which I propose to call
"construction." The practicing physi-cian,
through membership in his coun-ty
medical society, State Medical So-ciety,
and the American Medical Asso-ciation
is the main pillar of support.
This affiliation brings together the
physician in private practice and the
physician in public health in a fra-ternal
association. It provides social
relationships, one with the other, and
affords an opportunity for critical ex-amination
of the strengths and weak-nesses
of physicians in various fields of
practice. Each particular field deserves
and should enjoy the confidence and
respect of the others.
The private physician is trained to
diagnose and treat individuals, but he
is not trained or experienced in treat-ing
the body politic—the whole com-munity.
This body politic can be treat-ed
definitively only by a team of pro-fessional
health workers, engineers,
sanitarians, health nurses, technicians,
clerks, and others working together. To
delegate to or expect from the private
physician definitive treatment of civic
ills is failing the commimity and ag-gravating
any conflicts which may exist
between the physicians and the health
ofiBcer, as well as leaving the medical
profession vulnerable to attack by those
who wish to vilify our system of prac-tice.
The health department affords the
best single public relations medium the
medical profession can develop. An
active committee in each county med-ical
society is needed for consultation
with the local boards of health and
health departments. Such a committee
will make sure that our health services
are kept in useful fields. It is time for
us to take inventory and make a care-ful
appraisal of our services versus our
present needs, and also to plan dis-creetly
towards the needs of the future.
The Private Citizen—Unified Action
This brings us to the third support of
the tripod—the one which I call "Uni-fied
Action." Without the former sup-ports—
administration and construction
—the system of cormnunity health
would fail. Without a third support,
the other two would become ineffective.
While the health officer and private
physician are indispensable, the actual
working power should be drawn from
the citizens of the community. Such
power can be obtained only by coordi-nating
the efforts of the private physi-cian
and the public health practitioner.
The American people are greatly in-terested
in the alleviation of human
suffering, in the social implications and
economic penalties of disease, and in
The Health Bulletin January, 1954
the improvement of Man's lot through
preventive medicine and public health.
The public concept of disease has
changed from regarding it as inexor-able
fate or the wages of original sin
to tangible enemies which can be de-feated
by proper organization and
financial support. This change of atti-tude
has created a public demand from
which the physician and health oflBcer
cannot escape, lest by public pressure
and political power they find them-selves
subservient to bureaucracy.
The principal health need of any na-tion
as socially, technically, and scien-tifically
advanced as ours is an instru-ment
that will offer an intimate, per-sonal
service to which individuals can
turn for assistance and guidance, in
times of physical and mental distress,
and a basically sound diagnostic and
therapeutic service that will assure the
individual a good first line of protection
against the common hazards of illness
and injury. To a large degree—cultural-ly,
and in private practice—the family
physician is this instrument; therefore,
the health needs of a nation depend
upon the success or failure of the prac-ticing
physician in discharging his re-sponsibilities.
Loss of Confidence Despite Progress
I am aware of the remarkable prog-ress
made within the life span of this
generation, and I am also aware that
medical science is progressing at an al-most
unbelievable rate. Approximately
80 to 90 per cent of the therapeutic
agents and diagnostic tests which are
considered routine today were unheard
of or regarded as rarities a decade ago.
As these therapeutic adjuncts have
emerged from the laboratories to the
field of everyday practice, the health
of the community has proportionately
benefited.
More notable, however, than the re-cent
progress made in medical and
surgical techniques and immvmizations
has been the advance in environmental
sanitation, insecticides, nutrition, hos-pital
construction, economics, screening
tests, and mass surveys for early case
finding. The medical profession today,
as never before, is seeking better health
care for its people through continuous
research, improved methods of sanita-tion,
more careful inspection, stricter
enforcement of the Pure Food and Drug
Act, and many other day to day serv-ices.
The citizens of America enjoy the
best medical care of any country of the
world. The system of American medi-cine
is the best the world has ever
known, and the American Medical As-sociation
is acclaimed the medical lead-er
of the world. In spite of its record
of service, however, this system, which
is the best to be found, and which con-tinues
to get better, is being vilified by
those people to whom it is giving so
much.
Why?
I do not have all the answers for all
the whys, but I think we can find
many of the reasons from a statement
which appeared in an editorial in a
metropolitan newspaper several months
ago! "Many a man frankly doesn't
care whether the efficient machine in
the white coat is socialized or not, be-cause
he feels the machine doesn't give
a damn about him."
We should read in this not an atti-tude
of belligerence, but a disturbed
concern over the loss of confidence in
the American doctor. As the third sup-port
of the tripod, the private physician
has an opportunity to restore public
confidence in American medicine. We
have lost such confidence because we
who are presumably above the average
in our community, with superior train-ing
and unquestionable standing, have
failed to play our proper role as private
citizens.
The Fault and the Remedy
Why do medical men default in their
responsibilities as citizens? Is it because
we have concentrated on the scientific
aspect of medicine and lost touch with
the social, economic, and political reali-ties
of today? Has our scientific growth
isolated us from the complex problems
of modern civilization? As a result of
superior training and endowment, prac-ticing
physicians today should play a
major role in the affairs of the county,
January, 1954 The Health Bulletin
state, and nation. This we must do if
we are to retain our freedom not only
in medicine, but in our way of life.
As practicing physicians, we must
concern ourselves with the following:
1. We must keep flowing a never-ending
stream of scientific and techni-cal
advances in medicine, in order to
give our patients the best possible med-ical
care. The patient's right to skilled
medical care must always be respected.
There must be absolute teamwork and
liaison between the practicing physi-cian
and the various health agencies.
2. We must concern ourselves with
the economic, social, and political
aspects of medical care as it involves
the present and futvu-e welfare of the
American people. The patient's welfare
must always be our primary objective.
3. We must approach the futvure with
a keen insight into the new problems
which have been created by the rapid
progress of medicine. The prolongation
of life has produced the new problem
of finding ways and means to prevent
and control the degenerative changes
leading to chronic illness. The length-ened
life span has resulted in an ever
increasing burden of human suffering
attendant upon the vicissitudes of old
age and economic strain. If we aid
people by adding more years to life, we
must also aid them by adding more
life to years. As citizens we should use
our influence and knowledge in help-ing
to improve the attitude of industry
toward employing older persons and in
getting insurance companies to extend
medical coverage to protect the added
years.
A community, like a private business,
needs to talk out its problems. The peo-ple
need to imderstand what goes on
above and below the range of their im-mediate
vision. They need to under-stand
the complexity of their com-j
munity problems and the over-all effect
of these problems on their environ-ment,
their economy, their livelihood
• and their health, and to develop an
over-all program. Our task in such a
program is to make known the answers,
,' through community education and the
: promotion of soimd voluntary health
insurance plans. We see in this that
the solution of our main problems, as
an integral part of our community wel-fare,
through the thu-d leg of our tri-pod
is: (1) an atmosphere of friendly
understanding and health education
between doctors and the general public;
(2) recognition that the doctor of medi-cine
exists for the benefit of the people
and not for the benefit of the profes-sion;
(3) recognition that medicine is
a social as well as a biologic science;
(4) recognition that it is necessary as
never before for the private physician
to discharge his responsibilities as a
citizen.
Conclusion
The task of the future carmot be
solved by formulas alone. We must be
wise and understanding as well as
courageous, and as professional men
dedicated to the saving of human lives,
we must be willing to leave the direc-tion
of hvunan affairs to those who be-lieve
in duplicity, dishonesty, or force.
Leadership in moral responsibility is
sorely needed, and recognition of this
need will be the beginning of our reali-zation
that something must be done.
We must take every opportunity to
bring a knowledge of moral responsi-bility
into every facet of commimity
life. Our best friends in any community
are our patients who look to us as
leaders. We should take advantage of
this close, personal association to teach
them their moral responsibilities and
to show them that the health of a na-tion
rests on the health of its indi-vidual
citizens.
In order to have a healthy and
strong nation, we must be healthy and
strong ourselves. Reforms must come
from within and not from without.
When we see ourselves as private citi-zens
as well as physicians, and as an
integral part of our cormnunity, we
will then acknowledge our responsi-bilities
and lead others to do the same.
The community, the health service, the
social and economic structure of gov-ernment
will then reflect the honestry,
integrity, and ability of our profession.
We should remember that medical
men in the past won their standing,
8 The Health Bulletin January, 1954
not as scientific machines, but as sym-pathetic
and understanding human be-ings,
and we should obey His command,
"Go Ye and Do Likewise."
FLUORIDATION OF PUBLIC WATER SUPPLIES
By ERNEST A. BRANCH, D.D.S.
The Council on Dental Health of the
North Carolina Dental Society is spon-soring
this series of articles on Dental
Health. The writer, Dr. Ernest A.
Branch, is the Director of the Division
of Oral Hygiene of the North Carolina
State Board of Health.
Present Status of Fluoridation
The current state of fluoridation can-not
be termed the status quo, in the
popular use of that term, for it is con-stantly
changing. Fluoridation is a go-ing
concern with each week, even each
day, showing more and more evidence
in its favor and phenomenal gains in
its acceptance as a preventive measure.
From figures released November 1, 1953,
we find that in the Nation 15,914,227
people in 833 communities are drinking
fluoridated water. To this number will
be added 14,749,994 citizens of 366 com-munities
in which fluoridation has been
approved. The figures for North Caro-lina
show that fluoridation is in opera-tion
in 20 mimicipalities serving 513,620
people and that it has been approved
in 7 more towns with a combined popu-lation
of 146,797. In our State, then,
more than 660,000, or approximately
one-sixth of the population, will soon
be using fluoridated water. These fig-ures
do not include the 3,000,000 people
in the United States and an appreciable
number in North Carolina who have
been drinking water containing nat-urally
borne fluorides all of their lives.
It might be well to define the term,
fluoridated water. It is water to which
a small amount of a fluoride salt, a
natural constituent of water, has been
added in order to supply the deficiency
and bring the content to a certain
level which has been found to be bene-ficial
in reducing the incidence of tooth
decay. The generally accepted amount
is one part per million. This is such an
infinitesimal amount that a person
drinking 8 glasses of water a day for
16 years will consiune only an ounce.
We believe that the fact that many
water supplies are deficient in this
natural element is to be accounted for
through soil erosion. The fluoride salts
which are added to water are the same
ones which occur naturally. It will be
seen, then, that fluoridation is a matter
of nutrition and not medication. Add-ing
fluorides to water is comparable to
fortifying flour, that is, returning to
reflned flour the minerals and vitamins
which were taken out during the mill-ing
processes.
Last month we cited a few of the
many pilot studies in fluoridation.
There are now, as there have been for
years, many groups of physicians, den-tists,
bio-chemists, and other scientists
devoting much time and thought to
this fleld of research. The average citi-zen,
or even dentist, does not have the
time or the training in research tech-niques
to read and evaluate the vol-uminous
reports of the various studies,
experiments, and tests in order to de-cide
for or against fluoridation. As in
many other matters pertaining to
health we must rely on authoritative
sources for information and advice. Of
course, we should be certain that our
sources are authoritative.
Fluoridation has the backing of an
impressible array of scientific organiza-tions.
Among them are the following
groups with the dates of endorsement.
State and Territorial Dental Health
Directors, June 8, 1950
American Association of Public Health
Dentists, October 29, 1950
State and Territorial Health Officers,
November, 1950
January, 1954 The Health Bulletin 9
American Public Health Association,
November, 1950
United States Public Health Service,
April 24, 1951
North Carolina Dental Society, May
1, 1951
National Research Council, Novem-ber,
1951
American Medical Association, De-cember,
1951
The unqualified endorsement of these
societies and associations should assure
even the most faint hearted and cau-tious
that fluoridation is a safe and
effective public health measure. North
Carolina communities were "not the
first by whom the new was tried." We
hope they will not be "the last to lay
the old aside."
Fluoridation is a Community
Responsibility
In the discussion of the present status
of water fluoridation we listed some of
the National and State dental, medical,
and public health organizations which
have approved this preventive measure.
To this list may now be added the
American Academy of Pediatricians.
The recent endorsement of this group
of specialists in child health brings
added reassurance of the safety and
effectiveness of the fluoridation of com-munal
water supplies for the reduction
of the incidence of tooth decay.
As typical of the recommendations of
the several groups, we quote the one
adopted by the State and Territorial
Dental Health Directors.
"Resolved, That the State and Ter-ritorial
Dental Health Directors recom-mend
the fluoridation of public water
supplies for the partial control of
dental caries, where the local dental
and medical professions have approved
this program and where the community
can meet and maintain the standards
required by the State health authority."
This brings us to the procedure to
be followed by a communtiy wishing
to join the ranks of the 833 cities and
towns now adding fluorides to theii*
water supplies. First of all, it should be
understood that fluoridation is always
initiated locally. It is never imposed
on a community by a state or federal
agency. However, there are certain safe-guards
which have been included by
the North Carolina State Board of
Health in its policy which approves
and recommends fluoridation. These
requirements, in short, are: (1) that
the measure must be endorsed by the
local dental and medical societies, by
the local Board of Health, and by the
municipal governing body; and (2) that
the procedure for adding fluorides to
the water supply must comply with
standards established by the State
Board of Health.
The flrst move toward fluoridation in
a community may be made by any local
group, such as civic club or a parent-teacher
association. Information and
assistance may be secured from the lo-cal
dental society and health depart-ment,
as well as from the State Board
of Health and the State Dental So-ciety.
Of course, a preliminary step is
to determine the natural fluoride con-tent
of the water supply to find whe-ther
or not the addition of a fluoride
compound is indicated.
A matter of interest is the cost of
fluoridation. This is effectively answer-ed
in the title of a booklet by the
Public Health Service, "Better Health
from 5 to 14 cents a year through
Fluoridated Water." This represents
the per capita cost of the equipment,
amortized over a 20 year period, and
the yearly supply of the fluoride com-pound.
The three compounds generally
used are sodium fluoride, silicofluoride,
or sodiimi silicofluoride.
In conclusion, two reminders are In
order. For the first we quote a para-graph
from the above mentioned pub-lication.
"To gain the full benefits of fluori-dated
water, children must drink it
during the period their teeth are form-ing,
or from birth to about age 8.
Children who are older at the time
fluoridation is started receive some pro-tection
against dental decay, but not
as much as the younger children. The
protection obtained by children con-tinues
throughout life."
10 The Health Bulletin January, 1954
For the second reminder, we call
attention to the phrase in the resolu-tion
by the State and Territorial Den-tal
Health Directors, "for the partial
control of dental caries." The fluorida-tion
of water supplies is not a "cure-and
there is no evidence that it will
retard dental decay that has already
started.
"Visit your dentist" is still the most
important dental health rule. Regular
dental care is essential to good dental
all." It does not prevent all tooth decay health.
LEGAL PROBLEMS OF PUBLIC HEALTH
WILLIAM McW. COCHRANE, Assistant Director
Institute of Government
Chapel Hill, N. C.
It may be helpful, briefly, to trace
the history and pattern of health legis-lation
in North Carolina, as an aid to
understanding why our health laws and
regulations need attention today. The
first substantial piece of health legis-lation
applicable to the territory which
was later to become North Carolina,
was enacted in 1712 by the General
Assembly of the Province of Carolina.
It was entitled "An Act for the More
Effectual Preventing of Contagious Dis-temper."
It was, of course, a lifetime
quarantine law and it appointed a
Commissioner of Health for the pur-pose
of inquiring into the state of
health of persons arriving on vessels
into the ports of the province. At
that time the main port was Charles-ton,
but it also applied to the other
minor ports, minor at that time, but
lately becoming more important, which
were located in North Carolina.
In the 241 years between the General
Assembly of 1712 and the General
Assembly of 1953, literally himdreds of
pieces of health legislation have been
spread on the Statute Books of North
Carolina. Most of them were aimed at
the more effectual preventive of one
or another of the myriad of threats to
the public health which existed then
and exist now. In terms of sheer vol-ume
and number, however, compara-tively
few of our statutes enacted prior
to the Civil War had anything at all
*Read before the North Carolina Public
Health Association at Nags Head, N. C.
September, 1953.
to do with health. The statutory situa-tion
in 1854 illustrates this point. There
were very few statutes at that time on
our books having anything to do with
health. By that time though, there were
brief statutes for quarantine on ships
and in incorporated towns; in cases of
smallpox and other infectious diseases
there were rudimentary statutes. And,
they applied only after the situations
had gotten pretty bad; they weren't
very effective as preventive measures.
There was a statute providing for a
limited and very interesting meat in-spection.
There was one declaring stag-nant
water, dead animals, privies,
slaughter houses, and some objection-able
substances to be nuisances in sea-port
towns, even though some of those
things were necessary, they were nuis-ances
if they were not properly con-structed.
But, this statute didn't apply
to inland towns; there was no protec-tion
anywhere except in the seaport
towns. There was a statute providing
for the control of disease in cattle
which relied on a very ingenuous de-vice,
I don't know how well It worked.
No cattle could be transported from
place to place in this State without a
certificate to the effect that the cattle
were free from disease, and this certi-ficate
was a written statement to be
signed by any two Justices of the Peace.
The law also frowned on putting poison
in a neighbor's well, made it a mis-demeanor
to do that; it made the own-er
of a dog liable if the dog became
mad and bit someone else. And, that
January, 1954 The Health Bulletin 11
was the beginning of our Rabies Sta-tute.
All together, the state-wide Sta-tute
Laws, of North Carolina on the
books in effect for the protection of
public health at the time of the Civil
War could have been put on about 3
or 4 printed pages. By any standards,
the law offered very little more than
fragmentary protection to the public
health of the citizens of the time. Now,
it is familiar learning to you people in
public health what happened in public
health in the years immediately follow-ing
the Civil War.
During the next two decades after
that time, the State Boards of Health,
in roughly the modern pattern, were
established by statutes throughout the
country in a number of states. And
North Carolina followed suit with your
own State Board of Health with a sta-ture
enacted in 1877. This statute
designated the whole membership, the
entire membership of the State Medical
Society, as the State Board of Health,
and it was to act through a committee
which had an annual appropriation of
SlOO to carry on its work. Two years
after, this arrangement was terminated
by a statute which created a 9 member
board of health in the modern pattern,
which would be a regular department
of the State Government. However, it
wasn't until 1911 that the Board ac-quired
the services of the first full-time
administrator, the State Health
Officer, and began the development of
the modern agency staffed by pro-fessional
men and women working un-der
the general directions of the Board
of Health. This pattern of statutory
development of organized public health
work at the State level was very similar
to the development at the local level.
It is true that town government from
earliest colonial days had to concern
itself with threats to the community
health, and had to take action. The
action was usually emergency action
and was not often preventive, prospec-tive,
regulative action. But, it is also
true that organized health work under
the statutes in the modern sense at the
local level largely during the period
since the Civil War, was under a sta-tutory
pattern paralleling that of State
health work. North Carolina's first sta-tute
providing for a state-wide system
of county boards of health was enacted
in 1879 when the legislature decreed
that each coimty should have a county
board of health composed of the entire
membership of the county medical so-ciety,
plus the Chairman of the Board
of County Commissioners, the Mayor of
the county-seat town, and for some
reason, no reflection on the gentleman,
the county surveyor. I suppose his
familiarity with the conditions out in
the county accounted for his being on
that early board ... he was surveying
farms. This board was as unwieldly for
administrative purposes, as you can
readily see, as the original State Board
had been. And like the old State Board,
the 1879 county board functioned in
practice as something on the order of
a medical vigilante committee, organ-ized
to deal with epidemics, nuisances,
and similar urgent threats to the com-munity's
health, usually after they had
already begun rather than as an agency
administering the laws and regulations
aimed at preventing such disasters. Ac-cordingly,
such regulations as were
adopted by the county boards of health
in those days were mostly emergency
measures, to deal with urgent situa-tions.
And there were a few instances
of prospective and general preventive
rule making or regulation making.
There were a few cases that reached
the Supreme Court involving these
boards during those years, and they
illustrate the emergency or negative
nature of their work. Most of these
cases were cases upholding the power
of these boards to remove smallpox
victims to the county pest house. You
might say that a pest house was the
health center of its day, a far cry from
what, fortunately, we are coming to
see in North Carolina today.
It was in 1911, as most of you know
or have heard, that the county board
of health statute was first expressed in
substantially its modern form, with a
seven member board composed of both
lay and medical members. However, for
most of the State's counties this formal
L
12 The Health Bulletin January, 1954
statutory change had little immediate
effect on the type of health work which
was being locally administered. The
reason for that was simple, there were
no full-time health departments in the
counties and the change in the Statute
Law did not bring them into being, as
by a magic wand. In 1911 the only
county health department in the State
was Guilford, which was established in
that year. And, it was not until 1949,
I understand that the State reached
the 100% mark in that respect . . . full
time local health services.
Now a word about the cities and
towns during this long period. Incor-porated
municipalities in North Caro-lina
have had explicit statutory au-thority
under the General Law since
1893, and under particular town chart-er
provisions since Colonial Days, to
tax and spend, to adopt regulations,
and to impose penalities in the interest
of the public's health. They have what
is called plenary power, as do the
county boards of health. But, except
in a few instances, in a few of the most
popular centers, in largest cities, and
very few, most of the State's incor-porated
mimicipalities have left organ-ized
health work to the counties and
to the districts today. This is reflected
in the Statutes. Since 1877, the statu-tory
emphasis has been on the county
as the local unit for health work and
since 1935 this development has been
extended, as you know, under a statute
of that year, authorizing the creation
of multi-county, district boards of
health, with district health depart-ments
working under the district boards
of health. As the legislature gradually
worked out the statutory pattern of
State and local governmental machin-ery
for public health work, dm-ing this
roughly 50 year period following 1877,
it was also adding with each biennial
session to the collection of health laws
to be enforced by these agencies.
Now these additions to the Statute
Laws to date, these health statutes,
were often hard won victories, they
represented hard won victories after
long struggles in the legislative halls.
And, accordingly, often today they re-flect
the patchwork quality of legisla-tion
which is enacted as the fruit of
compromise between opposing factors.
Now, that is a process we are familiar
with, and it is a necessary process in
a democratic, representative govern-ment.
But, the result sometime is, and
it is the result in the case of some of
our health education that "like Topsy
it just grew." Sometimes a new statute
would be added without much refer-ence
to other statutes affected by the
new statute . . . the relationship wasn't
followed through, they didn't fit to-gether
properly, it was a patchwork
proposition, therefore, necessitating a
great deal of interpretation by the
health agents who are attempting to
enforce it and eventually by the lawyers
and the courts when things get a little
rough. By the late 20's I think it is
safe to say that most of this collection
of health laws was in its place on the
Statute Books of our State. Since that
time, relatively few changes have been
made over the last quarter century,
compared with the bulk of statutes
which are in effect today, which are
now older than 25 years. There have
been changes in every legislature, but
I mean the total bulk of the statute
law is older than a quarter of century.
And this same quarter of a century has
seen greater advancement of the activi-ty
of organized public health agencies
than they enjoyed in all their years be-fore
combined. There has been change
in the nature as well as growth in the
volume of organized public health work.
Public health is today defined much
more broadly than it once was, you all
know that. The coiu-ts are finding it out
on occasions. Health agencies have long
since extended their work, their sphere
of activity to include such vital con-siderations
of modern health, new con-cepts
to some of the people, but none
the less recognized as vital, as I under-stand
it, by you people, in increasing
degree. Such consideration as preven-tion
of occupational diseases, preven-tion
of accidents, elimination of slums,
elimination of bad living conditions,
looking at the total environment of the
citizen in your health work. The
January, 1954 The Health Bulletin 13
statutes have not kept pace with those
attitudes, they don't reflect them. They
reflect the traditional services which
you render. They are full of communi-cable
disease control and that sort of
thing which we have come to take for
granted as part of public health work.
A layman, a lawyer looking at what
you all are doing and looking a little
bit at the history of health work, as
one of those people, I am impressed
with this, that the expanded program
of State and local health departments
in North Carolina now flourishing here
would probably have seemed but an
irridescent dream. Twenty-five years
ago, no longer than that, in any coim-ty
in this State in terms of program,
in terms of money, in terms of staff,
the development has been enormous.
But during this same period, both State
and county boards of health have gone
through a transition from the stand-ards
of merely nominal regulation
making bodies . . . that is they had
the power to make the regulations but
it was for all practical purposes a
nominal power because it was not
broadly exercised and there were no
staffs to enforce the regulations which
were made . . . that is large staffs . . .
they have gone through this transition
from that status to the standards of
very active regulation making and
regulatory bodies, with large full-time
staffs, enforcing standards and regula-tions
which affect the interests, some-times
adversely when money has to be
spent, but affect the interest of an
increasing number of citizens in their
homes, in their businesses, and in their
persons ... for example the venereal
disease control statute. Property and
personal rights are affected to a much
greater degree than ever was the case
before in this field. And in this great
expansion of regulation and admini-stration
the process of improving the
techniques of the health sciences has
obviously far out stripped the process
of improving the health statutes, the
regulations and the legal and admini-strative
procedures of enforcement.
Public health personnel today, Univer-sity
trained in their specialities for
the most part, possessing the technical
knowledges and skills which they need
to protect and advance the public
health are not so well-equipped when
it comes to the legal aspects of their
work because of these things I have
mentioned. They don't find either quick
or clear answers to questions about
their powers and duties in their every
day work by looking for those answers
in the Statute Books. The result is that
often you have to play by ear rather
than by note because the notes aren't
there . . . certainly they are not easy
to find if they are there. I think that
most of us would agree that our statu-tory
provisions . . . praiseworthy though
they were at the time they were en-acted,
victories though they represent-ed,
pioneering efforts though they were,
are often full of meticulous details
about inconsequential or obsolete mat-ters
which aren't important any more
in public health. And, then they are
silent as the grave sometimes on mat-ters
which are widely recognized as
being vital parts of health department
programs. And, the statutes are more
than that, they are frequently am-biguous
and contradictory in many
places to the point of utter confusion.
For example, you are familiar with one
. . . one statute provides that the
county health oflBcer shall serve as
coimty physician, and another says he
may serve as county physician. The
practical effect of that, of course, is
to leave the decision with the county
board of health as to whether he shall
or shall not serve as county physician.
This same general comment can often
also be validly made about the regula-tions
made by our boards of health.
These regulations are often too hasted-ly
drawn, and usually unpublished, and
not always kept up-to-date, and they
are sometime inaccessible for all prac-tical
purposes not only to the public,
the citizens, but often even to health
department personnel. Now, you under-stand
that most of these things are
drawn by lawyers, of which I am one,
and it is not a matter of criticism
of anybody for the condition. These
are things that have just let slide over
14 The Health Bulletin January, 1954
a long period of years, and I think
that the major reason has been that
in health work, you emphasize persua-sion
and education and you don't go
to court until you have to. I think
that is the wisest thing in any law
enforcement program that I am fami-liar
with. The interesting thing is that
it works more effectively in public
health than it does in many others.
Prosecution seems to be necessary in
enforcing the general criminal laws of
the State. But in these circumstances,
it is not surprising that sometimes a
health officer or other health officials
or a sanitarian may discover that he
has been adhering to accepted sani-tary
or health standards and enforcing
them, only to find in court that the
regulations which he may have been
relying on have never been properly
expressed or adopted by a county board
of health and are, therefore, not valid.
I am sure you are all familiar with
examples of that situation. I certainly
have had enough conversation with
health officers and sanitarians to as-sure
me that that is widely the case.
Poorly drawn statutes and regulations,
of course, are not the exclusive pro-perty
of public health agencies. Justice
Harland Stone, of the Supreme Court
when he was Attorney General de-scribed
the general situation in these
words, "We make a prodigious number
of laws, in enacting them we disregard
the principles of draftsmenship and
leave in uncertainty their true mean-ing
and effect." I think if somebody
gave a committee here the power to
do nothing except go through all of
our health laws and repeal anything
this committee wanted to repeal, with
no power to add a line, we could prob-ably
come out with a better set of
regulations than we have to start with.
Certainly we could eliminate some con-flicts
that way. So the problem is not
more law, in fact it may very well be
that a properly drawn health code for
North Carolina would be a much
shorter thing and certainly a better
organized thing than our present
health statute. Alexander Hamilton had
a comment along the same line which
pointed to the dangers inherent in
confused and poorly drawn laws. He
said in 1878 in the Federalist Paper,
"It will be of little avail to the people
that the laws are made by men of their
own choice if the laws be so volumuous
that they cannot be read, or so in-coherent
that they cannot be under-stood
if they be repealed or revised be-fore
they are promulgated or undergo
such incessant changes that no man,
who knows the law, today can guess
what it will be tomorrow."
During the last two years, there has
been considerable interest in doing
something about the regulations of
county and district boards of health,
and I have had the pleasure of working
with a number of you in that connec-tion,
working with you on revising
ordinances, or regulations as the
statute terms them, of district and
county boards of health. There have
been regulations drawn in fields that
are new to county health codes which
supplement the regulations of the State
Board of Health; such as, regulations
of private water supplies, one county
now has; regulations of swimming
pools; regulations of trailer parks. Now
some of those things are products of
modern day science; of course private
water supplies we have had for a long
time. But, the trailer park problem
didn't exist a couple of decades ago and
it is illustrative of the new problems
and the new fields of regulations which
you folks in health work have had to
get into. But, it is also illustrative of
subject matter not dealt with in the
statutes covering in a general advance
of power and vmdoubtedly in the scope
of county boards of health as a legal
proposition. But there is a great deal of
that new material which the statutes
are about, which is one of the major
reasons why we need to look into the
conditions of these statutes.
Now, on the State side, the State
Statutes and the regulations of the
State Board of Health, the job of the
revision of the statutes to make them
fit the present day needs and practices
of State and local health agencies, is,
of course, a much bigger project than
January, 1954 The Health Bulletin 15
the job of revising the local regula-tions.
But, it is much more important,
much more urgent than the local ones
are. I am glad to be able to say that
preliminary research has already begun
toward this end, toward the study of
the problems looking toward the re-vision
of the State Health Laws, and
the preparation of a newly codified set
of State Health Laws. It was begun by
the staff of the Institute of Govern-ment
at the request of the State Health
Authority. Now this project was under-taken
by the Institute of Government
and the committees from the State
Board of Health and local health offi-cers
of the State, with the understand-ing
that committees representing the
various technical specialists in the fields
of public health would work closely and
advise the staff members of the Insti-tute
examining with care every pro-vision,
every detail of every provision,
of our existing health statutes with
the public health specialist making the
decision with respect to what should
be kept, what should be thrown away
in the statutes as they now exist. Out
of those conferences, and there will be
many such conferences, with many
people, and a good long time of hard
work, would come a tentative draft
which would be submitted to the health
folks all over the State for their sug-gestions
and study before presentation
to the General Assembly. This is a big
task as all of you know, and it will
require much time and work and plenty
of cooperation to bring it to comple-tion.
But, I do indeed think that it
represents the biggest, single legal
problem w^hich we face today in public
health in this State.
NOTES AND COMMENT
By THE EDITOR
BOVINE BRUCELLOSIS VACCINE
CAUSES INFECTION IN HUMANS
The first definite proof that direct
contact with the vaccine used to im-munize
cattle against brucellosis can
cause human brucellosis (undulant
fever) was reported in an article and
an editorial in the Journal of the
American Medical Association.
With this proof went the warning
that the vaccine contains a viable
pathogen, and that it should be han-dled
only by qualified persons, prefer-ably
veterinarians, and then with the
knowledge that accidental contact with
it may result in active brucellosis.
The case reports of two 25-year-old
veterinarians who became ill after acci-dental
infection with the vaccine, pro-duced
from Brucella abortus, strain 19,
while immimizing calves were described
by Drs. Wesley W. Spink and Hugh
Thompson, Minneapolis. The doctors
are associated with the department of
medicine and the student health serv-ice,
University of Minnesota Hospitals
and Medical Schools.
One veterinarian became infected
when the needle of the syringe con-taining
the vaccine accidentally enter-ed
the palm of his right hand. In the
second victim, the vaccine accidentally
splashed into both eyes. Both men be-came
quite ill, but recovered following
treatment.
"An effective means for immunizing
cattle against brucellosis involves the
infection of viable organisms of Br.
abortus, strain 19," the doctors stated.
"In the campaign to eradicate bovine
brucellosis, strain 19 is being used ex-tensively
in the United States and in
other countries where Bang's disease is
a problem.
"This report on human brucellosis
caused by strain 19 does not imply in
any way that the use of vaccine should
be curtailed. It does emphasize, how-ever,
that strain 19 is not innocuous
and that it should be handled only by
quaUfied persons, preferably veteri-narians,
and then with the knowledge
that the accidental introduction of the
organisms into the hioman subject may
16 The Health Bulletin January, 1954
be followed by illness."
The doctors pointed out that no
evidence has been presented to show
that persons have contracted brucel-losis
from cattle vaccinated with this
strain.
DRINKING AND EVIPORTANT
ACTIVITIES DON'T MIX
If you have something important to
do, don't drink beforehand.
The greatest danger from the use of
alcoholic beverages concerns the rela-tionship
of drinking to subsequent ac-tions,
a medical consultant wrote in
the Journal of the American Medical
Association, stating:
"For example, the after-dinner drinks
may be perfectly harmless if no im-portant
activities are undertaken at
such times, where as the drink taken
before driving a car, running machin-ery,
or performing any task that de-mands
accurate decisions or mental
acuity might be dangerous. The drinker
should observe the following rule: For
every two drinks, he should wait three
hours before undertaking important
activities."
Contrary to popular opinion, the mix-ing
of alcoholic drinks does not in-crease
the intoxicating effects of alco-hol,
since these symptoms depend on
the actual amount of alcohol consumed
and other factors, he stated. However,
this old wives' tale concerning the mix-ing
of beverages may be of value, since
promiscuous sampling is likely to lead
to greater consumption of alcohol, just
as a great variety of foods may lead to
overeating, he said.
Concerning the amount of alcohol
that can be tolerated by an individual,
the consultant pointed out that the
effect depends largely on one factor
—
the amount of alcohol that accumulates
in the blood.
"The amount that accumulates de-pends
on the amount ingested, the size
of the person, the concentration of
alcohol in the beverage, the presence
of food in the stomach, the rate of
oxidation and elimination of the alco-hol,
and, particularly, on the rate of
drinking," according to the consultant.
"The average person can oxidize and
eliminate about six to ten cc. of pure
alcohol per hour, so that he could con-sume
about a pint (500 cc.) of 100 proof
whiskey in 24 hours without ever being
intoxicated if he spaced his drinks pro-perly.
On the other hand, a single
drink consumed rapidly on an empty
stomach may produce measurable
symptoms of intoxication.
"A convenient guide for comparison
of the amount of alcohol in beverages
is that one ounce (30 cc.) of 100 proof
whiskey contains about as much alco-hol
as three ounces (90 cc.) of wine
(17 per cent by volume) or 12 ounces
(360 cc.) of beer (four per cent by
volume)."
URGES STANDARDIZATION,
INCREASED BED CAPACITY
OF NURSING HOMES
The time has come for the standard-ization
and an increased bed capacity
of nursing homes, in the opinion of
Dr. Thomas P. Murdock, Meriden,
Conn.
"The overloading and overburdening
of the general hospitals, the increased
cost of hospitalization, the increase in
life expectancy, the large niunbers of
persons covered by prepaid hospital
and medical plans, and the undoubted
increase in the number of persons
suffering from long-duration illness all
indicate that from this time on the
nursing homes will take their rightful
places in the sim," Dr. Murdock, a
member of the board of trustees of the
A.M.A., wrote in the Journal of the
American Medical Association.
The life expectancy and aged popula-tion
in the United States are con-tinually
increasing. Dr. Murdock point-ed
out. Statistics have shown that old-er
persons are particularly prone to
such long-duration illness as heart and
blood vessel diseases and cancer. Great
numbers of these patients with long-duration
and probably incurable ill-nesses
in general hospitals could be
cared for as well, if not better, in nurs-ing
homes.
MEDICAL LIBRARY
U . OF N. C
.
CHAPEL HILL. N. C.
I TKis Bulletin vdll be sent free to arwi ciiizen of ri\e 5iate upon request I
Published monthly at the office of the Secretary
Entered as second-class matter at Postoffice «t Raleigh,
of the BoardrtflelgWDiVirn
N. C. under H{o^(gits«2<^ UA2
Vol. 69 FEBRUARY, 1954 No. 2
DiVlSIOl Of
_^^ft^€^
Wi %
^^•^^ "i-
DR. H. LEE LARGE—1891-1954
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
G. G. Dixon, M.D., President Ayden
Hubert B. Hayv/ood, M.D., Vice-President Raleigh
H. Lee Large, M.D Rocky Mount
John R. Bender, M.D Winston-Salem
Ben J. Lawrence, M.D Raleigh
A. C. Cxirrent, D.D.S Gastonia
H. C. Lutz, Ph.G Hickory
Geo. Curtis Crump, M.D Asheville
Mrs. J. E. Latta Hlllsboro. Rt. 1
EXECUTIVE STAFF
J. W. R. Norton, M.D.. M.P.H., State Health Officer
John H. Hamilton, M.D., Assistant State Health Officer and Director
State Laboratory of Hygiene
C. C. Applewhite, M.D., Director Local Health Division
Elmest A. Branch, D.D.S., Director of Oral Hygiene Division
A. H. Elliot, M.D., Director Personal Health Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
Fred T. Foard, M.D., Director Epidemiology Division
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin, which will
be sent free to any citizen requesting It. The Board also has available for
distribution without charge special literature on the following subjects. Ask
for any in which you may be Interested.
Diphtheria
Flies
Hookworm Disease
Infantile Paralysis
Iniluenza
Malaria
Measles
Scarlet Fever
Teeth
Typhoid Fever
Typhus Fever
Venereal Diseases
Residential Sewage
Disposal Plants
Sanitary Privies
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent free to
any citizen of the State on request to the State Board of Health, Raleigh, N. C.
Prenatal Care
Prenatal Letters (series of nine)
monthly letters)
The Expectant Mother
Infant Care
The Prevention of Infantile Diarrhea
Breast Feeding
Table of Heights and Weights
Baby's Daily Schedule
First Four Months
Five and Six Months
Seven and Eight Months
Nine Months to One Year
One to Two Years
Two to Six Years
Instructions for North Carolina
Midwives
Your Child From One to Six
Your Child From Six to Twelve
Guiding the Adolescent
CONTENTS Page
Rites Planned Sunday For Dr. Large 3
An Uncommon Man 4
Public Health Aspects of Cooking Garbage For Hog Feeding 5
Good Teeth—For You, Your Child, Your Community 8
A Conquering Hero 9
Notes And Comment 12
[£]| |PU6LI5MED'ByTAE N1'>RTA CAFloLlNA STATE B^AaP-^ AEALTA] IJ^J
Vol. 69 FEBRUARY, 1954 No. 2
J. W. R NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor
RITES PLANNED SUNDAY FOR DR. LARGE
Rites will be held here on Sunday
for Dr. H. Lee Large, prominent Rocky
Mount physician who was actively
identified with public health, both on
the local and state levels, for many
years. Dr. Large died late yesterday
afternoon in a local hospital following
a long illness. He was 62 years old.
The Rev. Ira A. Kirk, pastor of the
Fu'st Christian Church, will conduct
the funeral services at 3 o'clock Sunday
afternoon from the home, 936 Sycamore
Street. Burial will follow in Pineview
Cemetery. The family has requested
that no flowers be sent. However, those
interested were asked to contribute to
the building fund of the First Chris-tian
Church of which Dr. Large was a
member.
At the time of his death. Dr. Large
was the senior member of the State
Board of Health. He had been Rocky
Moimt's first health officer and was one
of the pioneers in public health work
in North Carolina.
The following statement was includ-ed
in resolution passed by the State
Board of Health in 1951 and forwarded
here today by oflQlcials of the state
agency
:
"Dr. Large has brought to the board
a wealth of experience in public health.
In fact, he is the only board member
who has served as a public health
officer. We do not recall a single reso-lution
introduced by Dr. Large before
•Rocky Mount Evening Telegram, Jan. 30,
1954
the board which has not been carried
without dissent. He has more than
once poured oil on troubled waters at
meetings of this board when trouble
and dissension was brewing or present."
Dr. Roy Norton, state health officer
and one time city health officer in
Rocky Mount, declared in a statement,
"I have never known a more devoted,
conscientious and energetic worker to-ward
every thing for the betterment
of his community and state than Dr.
Lee Large. He gave freely of his time
and energy and served through more
than one period of several months as
city health officer while refusing to ac-cept
remuneration for these services.
His passing is a loss to thousands in
the city and state he loved but his good
work will continue to add health and
happiness to many who never knew
him."
Last year, the City of Rocky Moimt
paid tribute to Dr. Large by naming
for him the new health center, soon to
be constructed here.
Dr. Large was a graduate of the
Medical College of Virginia at Rich-mond
in the class of 1917. He started
his work with the City of Rocky Mount
in the fall of 1917, serving as city
health officer imtil 1931 when he be-came
connected with Park View hospi-tal
as urologist. He was also urologist
for the Atlantic Coast Line Hospital
here. Since 1931 he had served as con-sxilting
or relieving health officer.
Also in 1931 the late Governor O.
The Health Bulletin February, 1954
Max Gardner named Dr. Large to the
State Board of Health. He remained a
member of that board vmtil his death.
A past president of the local medical
society. Dr. Large also took an active
part in coimty health aflfairs in Nash
and Edgecombe and was an active
member of the State Medical Society.
Dr. Robert Walker, present Rocky
Mount health ofBcer, paid the follow-ing
tribute:
"In the loss of Dr. Large, Rocky
Mount and the State of North Carolina
suffered a severe loss. He was one of
the pioneers in public health work and
his whole heart was wrapped up in
serving the health needs of the city
and the State. No single man in the
State has done as much for public
health work as Dr. Large."
Dr. Large was a native of Virginia,
the son of the late D. W. W. Large and
Mrs. Emma Botts Large. His mother,
who survives, lives in Appalachia, Va.
He was born October 6, 1891. He mar-ried
the former Nellie Pearle Brockwell
of Richmond, Va., who survives.
In addition to his mother and his
wife. Dr. Large is survived by three
sons, Dr. H. Lee Large, Jr., of Char-lotte,
Dr. Nelson D. Large of Alex-andria,
Va., and Harry S. Large of
Huntington, W. Va., two daughters,
Mrs. Harry Hollingsworth of Durham
and Mrs. Fred Best of Columbus, Ga.;
and one brother, Stallard Large of
Appalachia, Va.
Pallbearers for the funeral on Sun-day
will be Dr. Robert Walker, Dr. C.
T. Smith, J. W. Sexton, Earl Ewer, D.
S. Johnson and Neal Adkins. Honorary
pallbearers will be members of the
Boice-Willis Clinic and the Edgecombe-
Nash Medical Society.
AN UNCOMMON MAN
The passing from our midst of Dr.
H. Lee Large leaves a great vacancy in
the life of this community, this state
and in many hearts. We shall miss
him.
We shall not see his likes again soon.
In an age which placed a premium
on mediocre conformance to colorless
mass standards, he dared to be a non-conformist.
The many-faceted range of
his personality sparkled and illumined
a great spirit and gave eloquent testi-mony
of the grandeur and sacred worth
of the hxmian individual. The force of
his personality, the strength of his
character, the nobility of his piu-pose
set him apart from his fellowman. He
was an imcommon man.
The world—particularly North Caro-lina—
is a little healthier, a little
•Rocky Mount, N. C. Sunday Telegram,
Sun., Jan. 31, 1954
brighter, a little happier because Lee
Large passed this way. His service
reached out far beyond those who look-ed
to him as their physician. In infinite
ways his work touched the lives of
countless people everywhere in North
Carolina who have benefitted from the
public health program.
Truly no other North Carolinian has
done so much for public health in this
state as Dr. Large. He was the senior
member of the State Board of Health
and had pioneered in the state's public
health program. In 1917 he became the
city's first public heatlh officer and
served until 1931 when he became a
member of the State Board of Health.
We rejoice that he lived to see his
labors bear fruit and to see his name
honored among men in so fitting a
memorial as the new health center in
Rocky Mount which will bear his name.
Hail and farewell!
February, 1954 The Health Bulletin
PUBLIC HEALTH ASPECTS OF COOKING
GARBAGE FOR HOG FEEDING*
By MARTIN P. HINES, D.V.M., M.P.H.**
North Carolina State Board of Health
Those of us who are servants of the
people in the profession of pubhc
health have or should have an interest
in everything that directly, indirectly,
or remotely affects the public health.
The subject of feeding raw garbage to
swine certainly falls in this category.
The present widespread outbreak of
vesicular exanthema (hereafter called
"V.E.") which threatens the swine in-dustry
has greatly promoted the cook-ing
of garbage fed to swine. Public
health ofiBcials are taking advantage of
this widespread interest in "V.E." to
stimulate and promote the control of
diseases of swine transmissible to man.
Of these, trichinosis is of most import-ance.
The feeding of tmcooked garbage to
hogs under the usual insanitary con-ditions
should not be tolerated by a
conscientious local governing body. I
do not take the position that garbage
should not be fed to swine. The United
States Department of Agriculture in
1941 estimated that 200 million poimds
of pork could be produced annually if
all garbage produced in the urban
areas of the United States were utilized
for hog feeding.
Producing human food from garbage
is obnoxious to say the least, but when
we consider that our population in 1975
will reach 200 million and that most
other countries have an even higher
birth rate, it is very probable that the
day will come when our children's
children may be happy to have food
produced from garbage.
The practice of feeding imcooked
garbage to hogs under insanitary con-ditions
affects the public health in
four different ways, namely, those dis-
• Presented at the 1953 Inter-state Sanita-tion
Seminar, Athens, W. Va. Augxist 24-
28, 1953.
•Chief, Veterinary Public Health Section.
eases directly transmissable from swine
to man, those diseases that affect sole-ly
swine and other animals, those ani-mal
diseases which are extremely dan-gerous
from a civil defense standpoint,
and miscellaneous public health prob-lems.
I shall elaborate briefly on each
of these.
Diseases Transmissible to Man
1. Trichinosis. The life cycle of this
parasitic disease of man is well known.
The incidence of trichinosis in both
man and animals in the United States
is the highest of any coxintry in the
world. England and Canada both have
long practiced cooking of raw garbage
fed to swine and consequently have
about one-twelfth of the human infec-tion
foimd in the United States. One
person out of six in the United States,
or about 25,000,000 of those alive today,
probably harbor trichinae. To reach
this total there would have to be 350,-
000 new infections each year. Using 50
larvae per gram as the threshold for
producing symptoms, 4.5 per cent of all
persons infected or about 16,000 should
exhibit clinical symptoms each year.
This is a great deal higher than the
average of 300 cases reported each year
in this coxmtry. Difficulty in making a
clinical diagnosis, inadequate reporting,
and mildness of symptoms are respon-sible
for the small number of reported
cases. It is estimated that of 60,000,000
hogs slaughtered each year in the
United States, 1.5 per cent are infected
with trichinae. The majority of the
950,000 infected swine can be blamed
on raw garbage feeding. A recent study
by Schwartz indicates that the preval-ence
of trichinosis in farm-raised swine
is only 0.63 per cent compared to 11.21
per cent in garbage-fed hogs. It is said
that during a lifetime each pork eat-ing
American wUl eat infected pork 200
times. Whether or not this pork has
6 The Health Bulletin February, 1954
been properly cooked will determine its
infectivity.
Before leaving the subject of trich-inosis
a few comments should be made
about protection against this parasite
through meat inspection. The federal
meat inspection service (U. S. D. A.)
makes no attempt to inspect swine car-casses
for trichinae. To do so would be
futile and leave the public with a false
sense of security. They do, however,
require all pork products customarily
eaten without cooking to be processed
(heating or freezing), in order to kill
the trichinae. A recent survey found
that products treated in this manner
contained only dead trichinae. Bacon,
fresh pork sausage and similar break-fast
sausage, ham, pork shoulder and
fresh pork cuts that have been cured
but not smoked or otherwise processed
should be thoroughly cooked before
they are eaten.
It is easy to see how trichinae can
get into the food of an innocent diner
if pork sausage is served. You have all
seen a cook place a patty of sausage
on the work board by the grill, pat it
out, and then place it on the grill to
cook. Later the bread is placed on the
board where the raw sausage was.
When sausage is done, it goes on the
bread and the sandwich is picked up
with raw shreds of meat that adhere
from the board. And how about the
"hamburger joint" which partially sub-stitutes
pork for beef in the hamburger
when the price of pork is cheaper than
beef. You have eaten these hamburgers
that are so rare they "moo" at you!
Yes, even if we do cook our garbage
fed to hogs, we must continue our
educational efforts toward the adequate
cooking of all pork products.
2. Salmonellosis. Over 200 species of
salmonella have been described and
many are found in swine. Causing a
food infection in man when contami-nated
food is ingested, salmonellosis
outbreaks are frequent among garbage
fed hogs. Poor sanitation contributes
to the spread of this disease, but it can
be eliminated if hogs are placed in
clean pens and given a ration contain-ing
no raw garbage.
3. Tuberculosis. Swine are susceptible
to all three types of tubercle bacilli.
The human type is almost always
found in swine fed on raw garbage;
therefore, it is quite dangerous to feed
swine uncooked garbage from hospitals
and sanatoria. One study reported 30
per cent of hogs fed on garbage from
a tuberculosis sanatorium were infected
with the hiunan type of the disease.
4. Swine Erysipelas causes a septi-cemia
in swine when acute, and joint
involvement when chronic. In man a
local lesion at the site of injury is
produced upon contact with infected
swine. Poultry are also affected with
this disease. It is believed that meat
scraps in uncooked garbage causes the
spread of this disease among swine.
5. Brucellosis, (undulant fever) In
general, this disease in swine has a
greater clinical resemblance to brucel-losis
in man than the disease in cattle.
Hutchings in a study revealed that B.
suis could be isolated from organs and
tissues of infected animals held at 40°
F. for as long as 20 days after slaught-er.
One could conclude from this study
that raw garbage could easily spread
this disease through swine to man.
Diseases Affecting' Only Animals. Any
diseases that affect the health of our
livestock affect the public health, both
from the standpoint of a loss of food
supply and the damaging effects to
our agricultural economy. Hog cholera,
"V.E.," and foot-and-mouth disease are
the most important diseases spread
through raw garbage feeding.
1. Hog Cholera. Hog cholera is the
most important hog disease in the
United States. The mortality is high
and vaccination must be carried out
each year, once a farm is infected. Un-cooked
pork scraps in garbage carry
the virus. Garbage feeders in Canada
cook their garbage and there is no
cholera in Canada! The United States
now realizes that this disease must be
eradicated. Heat treatment of garbage
will contribute much to the success of
this campaign, for Dr. B. T. Sims, Chief
of United States Bureau of Animal
Industry, says, "We can never elimi-
February, 1954 The Health Bulletin
nate hog cholera as long as we feed
raw garbage."
2. Vesicular Exanthema. A disease of
swine which first appeared in Cali-fornia
in 1932 and remained endemic
in this state until 1952 when it spread
eastward. In 1952 infected hogs were
first seen in Grand Island, Nebraska,
and originated from a garbage feeding
lot in Cheyenne, Wyoming. Shortly
thereafter the disease spread to 32
states. Most outbreaks have occurred
in raw garbage feeding establishments
while some were in grain-fed hogs that
contacted diseased hogs en route to
market. Immediately after the outbreak
was recognized, the price of pork drop-ped
substantially and many people
perhaps stopped eating pork because
of the adverse publicity, pointing out
the effects on the economy. Tlie great-est
thi-eat of "V.E." is that it resembles
foot-and-mouth disease and every case
must be differentiated by expensive
animal tests.
3. Foot-and-Mouth Disease. The last
two outbreaks of foot-and-mouth dis-ease
in this coimtry started in hogs fed
raw garbage. Before stopping these
outbreaks, 975 farmers had their herds
destroyed and it cost the United States
$100,000,000 to stamp out the disease.
In recent years we have spent over
$200,000,000 to keep the disease from
entering this country from Mexico. No
wonder we are terrified at the existing
possibility of "V.E." masking foot-and-mouth
disease all over the coimtry.
Transmission of foot-and-mouth dis-ease
virus by infected meat scraps has
been known for a long time.
Civil Defense. Among the animal dis-eases
that have been listed as those
most likely to be used against us in
biological warfare aimed at "knocking
out" our food supply are foot-and-mouth
disease, rinderpest, exotic strains
of hog cholera, Asiatic Newcastle dis-ease
and fowl pest. Our civil defense
authorities already are greatly con-cerned
by the confusion that the re-cent
outbreak of "V.E." is causing be-cause
of the marked clinical similarity
to foot-and-mouth disease and of the
extensive diagnostic procedures neces-sary
to differentiate the two on the
occasion of each new outbreak. Actual-ly
this is of more importance to cattle
men because of the jeopardy in which
it places our cattle industry by pos-sibly
having foot-and-mouth disease
masked as a hog disease. There is little
doubt that our enemy will use all pos-sible
means to create confusion and
disaster. What better means could be
used than by seeding our country with
exotic livestock diseases?
Miscellaneous Public Health Pro-blems.
There are several other prob-lems
created by garbage feeding under
insanitary conditions such as:
1. Solid wastes left from garbage
feeding if not disposed of fre-quently
blocks drainage and causes
prolific breeding of mosquitoes.
2. Presence of flies, vermin and rats.
The latter spread trichinosis among
hogs and also transmit other seri-ous
diseases to man (typhus, lepto-spirosis)
.
3. Obnoxious aerial nuisances are
present which local health depart-ments
are often requested to have
abated.
4. Business and industry are reluct-ant
to move into such an area be-cause
of the strong odors and un-sightly
conditions, making pro-perty
values and tax returns low.
In conclusion, I am happy to report
that North Carolina now has a law
requiring the cooking of all garbage
fed to swine. This law also takes into
consideration the sanitation of such
feeding establishments, including rat
and fly control. It is administered by
the State Veterinarian imder the De-partment
of Agriculture. There is com-plete
cooperation between local and
state health officials, with agriculture
ofBcials responsible for the enforcement
of this law. At present, seven laymen
and one veterinarian are employed to
inspect garbage feeding establishments.
Although we have never been a heavy
garbage feeding state, we do have sev-eral
military installations that are pro-viding
garbage feeding problems. It is
really ridiculous that a nation as civil-ized
as we claim to be has permitted
8 The Health Bulletin February, 1954
for so long a time a situation where
one-half of one per cent of the garbage
fed livestock imperils the entire agri-cultural
economy of the covmtry, not
to mention the important public health
aspects of garbage feeding. I believe at
last we have awakened to the fact that
the prevention, control and eradication
of trichinosis, vesicula exanthema and
foot-and-mouth disease depend upon
the elimination of raw garbage feeding
of livestock in the United States. We
are at last heading in the right direc-tion.
GOOD TEETH—FOR YOU, YOUR CHILD,
YOUR COMMUNITY
The Council on Dental Health of the
North Carolina Dental Society is spon-soring
this series of articles on Dental
Health. The writer, Dr. Ei-nest A.
Branch, is the Director of the Division
of Oral Hygiene of the North Carolina
State Board of Health, Raleigh, N. C.
Topical Application Of Sodium
Fluoride To Children's Teeth
In previous articles the case for
fluoridation of commimity water sup-plies,
as an effective and safe large-scale
means of reducing dental decay
has been presented. Fluoridation, you
will recall, is the adjustment of the
fluoride content of the public water
supply to one part fluoride to one mil-lion
parts water. The results of much
research during the past flfty years
substantiate the finding that persons
who used fluoridated water since birth
have two-thirds less tooth decay than
those who have used fluorine-free
water. Fluoridation has been endorsed
by the leading dental, medical, and
public health groups.
To-day, we are thinking about the
children who live in areas where there
are no municipal water supplies—chil-dren
who live on farms and in small
villages. In North Carolina, with a pre-dominantly
rural population, there are
literally thousands of children who
carmot drink fluoridated water.
Fortunately, these children, too, can
benefit from fluorides. Researchers
have discovered and perfected a meth-od
for applying sodium fluoride direct-ly
to the surfaces of teeth. This is
called the topical application of sodium
fluoride. Surveys have shown that this
treatment has reduced dental decay by
40 per cent in large groups of children.
Please note the modifying phrase, "in
large groups of children." Parents
should know that results vary among
individuals and that evei-y child may
not be benefitted. However, we believe,
along with the Council on Dental
Health of the American Dental Asso-ciation,
that the favorable results justi-fy
our recommending to parents the
topical application of sodium fluoride
to their children's teeth by their den-tists.
For this partial protection against
tooth decay a two per cent solution of
sodium fluoride is used. The dentist
cleans the teeth thoroughly before the
first application. He then dries the
teeth with compressed air. To the dried
enamel surfaces he applies the two per
cent solution of sodium fluoride, allow-ing
it to dry on the teeth. A series of
four separate applications is given at
intervals of from three days to a week.
Four applications are essential for
maximum effectiveness.
The first such series of treatments
should be given when a child is three
years old to protect his baby teeth. The
treatments should be repeated at three
to four year intervals, or at about the
ages of 7, 10, and 13 years. In this way
all teeth will be treated soon after
they come in the child's mouth. If
applications have not been given at the
suggested ages, they may be given later
for they are effective at any age under
16.
As stated above, the topical applica-tion
of sodiimi fluoride is recommend-ed
for children in rural areas and for
February, 1954 The Health Bulletin 9
children in towns which have not yet
fluoridated their water supplies. Water
fluoridation, where possible, is more
economical and far reaching as a pre-ventive
measure.
Neither the fluoridation of water
supplies nor the topical application of
sodium fluoride will prevent all tooth
decay. Other measures recommended
for the promotion of good dental
health are:
1. Regular visits to the dentist for
the early detection and correction
of dental defects.
2. Brushing the teeth immediately
after eating.
3. Eating a balanced diet with sweets
reduced to a minimum.
A CONQUERING HERO
By WILLIAM H. RICHARDSON
State Board of Health
Raleigh, North Carolina
In view of the fact that North Caro-lina
recently dedicated a hospital for
the treatment of tuberculosis at Chapel
Hill, which cost $1,186,000 we are going
to consider in this article the evolution
of sanatorium treatment for tubercu-losis,
together with some facts about
the pioneer in that field in the United
States. The new institution was named
in honor of the late Lee Gravely of
Rocky Mount, whose efforts in behalf
of tuberculosis sufferers marked him
as a great North Carolinian.
This country of ours have produced
many heroes who did not wear imi-forms.
One of these was Edward Liv-ingston
Trudeau. He was born in New
York City, October 5, 1848. His father
and his maternal grandfather both
were physicians. When he reached ma-turity
he, himself, decided to follow in
his father's and grandfather's footsteps
and enter the medical profession. This,
however, was after the death of his
brother, who was a victim of tubercu-losis.
Prior to his brother's death, he
had decided to enter the navy. He was
about to enroll at Annapolis when his
brother became ill, and he decided to
remain with him, instead of pursuing
his original intention.
Trudeau entered medical school in
1868. Upon completing his studies, he
married and began practicing in New
York. Soon he began to feel tired all
the time, and was advised to have his
lungs examined. The physician who
examined him found that, his left lung
was actively tuberculous. At that time
tuberculosis, which was called con-sumption,
was considered absolutely
fatal. This diagnosis altered the pat-tern
of Trudeau's whole life.
Braced For A Fight
After being told he had tuberculosis,
he said that he was at first stunned,
and the world seemed to black out.
Thinking, he had only a short time to
live, he decided to go to the Adiron-dacks,
in order to be out in the open
as much as possible. He reached his
destination in May, 1873, and took up
residence at a hunting lodge. Life in
the mountains improved Trudeau's
health. He began to eat and sleep
normally and his fever left him. He
returned to New York, in September,
having gained 15 pounds. Before long,
however, he began slipping again, so
he decided to spend the next winter
in the mountains.
The lodge keeper finally was per-suaded
to let him remain for the
winter months. The feeling at that
time was that a person with tubercu-losis
should go to a warm climate. On
one occasion, during his winter stay
in the Adirondacks, it was necessary
for Trudeau to take shelter in a snow
cave, on his return to the lodge. He
went through that first winter almost
free of fever. When the guests began
to return, the following spring, they
10 The Health Bulletin February, 1954
were astonished to learn that Trudeau
and his wife had remained up there
throughout the winter.
Upon the decision of the lodge keep-er
to move to another location and
open a hotel for the winter, Trudeau
began looking for a place where he
could have a house of his own. He
finally decided to take up residence
on Saranac Lake. He rented a house
from a guide. The keeper at the lodge
where he formerly stayed lent him
some furniture. He spend much of his
time hunting. Sometime after arriving
at Saranac Lake, he was struck by a
brilliant idea—that of building a sana-torium
similar to Brehmer's in Silesia,
in Europe. Brehmer first used the
sanatorium treatment in pulmonary
tuberculosis cases.
In the summer of 1882, Trudeau met
Dr. Alfred Loomis, who had treated
him, from time to time, and told him
of his plan to build a cottage at
Saranac Lake, where patients of mod-erate
means could get rest and care,
and where he could start his sanator-ium
methods of treating tuberculosis.
Dr. Loomis agreed to send Trudeau
patients and to examine them free of
charge.
When Trudeau went do'wn to New
York that summer, he called some of
the people he knew and asked for sub-scriptions
for the sanatorium. Many
could not understand what he was try-ing
to do. They argued that tubercu-losis
could not be cured. However, he
did collect more than $3,000. He kept
adding to the sum and, finally, was
sure that, in due time, he could start
putting up a small building. The first
cottage was completed in February,
1885. It had just one room, 14 by 18
feet, and a porch so small that only
one patient could sit there at a time.
The fii'st occupants were two factory
girls, who had been sent up by Dr.
Loomis.
Inspired By Koch
While Trudeau was at work plan-ning
his sanatorium, Koch, who was a
German scientist, annoimced that he
had discovered the tuberculosis bacil-lus.
This occurred in 1882. Then the
germ theory v/as comparatively new.
Trudeau had read of the experiment
of Pasteur, the French scientist, who
believed that all infectious diseases
came from living organisms. He learn-ed
much of the work of Lister, who
had proved that antiseptics could keep
wounds from becoming infected. When
he learned of the discovery of Koch,
regarding tuberculosis bacillus immedi-ately
he became very much interested.
He felt that if he could learn to grow
the bacillus outside of the body and
then give tuberculosis to animals, he
might be able to discover something
that would kill the bacillus in human
beings.
He went to New York and begged
some of the old professors to teach
him how to find the bacillus. While
they were indifferent to the discovery
claimed to have been made by Koch,
he saw in it a whole new world, in
the field of fighting tuberculosis.
They gave him a place, in a dingy
old laboratory; and, after much work,
he was able to find tuberculosis bacil-lus.
The next step was how to conduct
experiments that would show how to
be able to kiU it in the human body,
if possible.
When he returned to Lake Saranac,
he fitted up a room, 8 by 12 feet, in
a frame cottage, and began the tedious i
task of making experiments. He faced
many discouraging situations, but kept
constantly at work for humanity. All
the while, friends put up many build-ings
for his sanatorium; they helped
him manage the funds collected. The
physicians of the younger generation
kept him supplied with knowledge they
gained.
Experiments With Rabbits
He experimented with rabbits, to
learn how changes of climates, rest,
fresh air, and food affected the germs
of tuberculosis, after they had entered
the body. These experiments proved
to Trudeau that bad surroundings, in
themselves, did not cause tuberculosis,
but that, once the disease had develop-ed,
it was greatly influenced by a
February, 1954 The Health Bulletin 11
favorable or unfavorable environment.
The essence of the sanatorium treat-ment
that Trudeau carried out was a
favorable environment, so far as clim-ate,
fresh air, food, and regulation of
the patient's habits were concerned.
This same principle still is used in
sanatorium treatment of tuberculosis
in North Carolina and elsewhere, and
it has prolonged countless lives.
As the years went by, the sanatorium
at Lake Saranac grew steadily, in
building, equipment, and in staff mem-bers.
But this great human benefactor
was not without his personal sorrows,
as well as his joys. Between 1893 and
1904, during which time the sanatorium
was steadily growing, he lost his
daughter, who was a beautiful and
promising young woman, and his son,
Ned, who already had begun practicing
medicine in New York City. He made
the statement that, during these dark
and sorrowful days, it was the sym-pathy
of his friends that kept him
going. Despite his great losses, Tru-deau
maintained his courage and con-tinued
to carry on his work, with an
indomitable will. He reached the end
of his earthly journey in 1915, but the
work which he did will ever live as a
: tribute to one of the great soldiers in
I
the battle against tuberculosis.
, While, to the man on the street,
the name Trudeau may mean little or
nothing, to those engaged in the work
' of endeavoring to find new ways and
means of combating tuberculosis, it
will remain a synonym for hard work
and coiurage. It must be remembered
that he, himself, fell victim to tuber-culosis
early in life, and that it was
this fact that inspired his great fight,
after he had conquered the disease in
his own life. In saving himself, he
endeavored to save others.
||
Some Tangible Results
If Trudeau were alive today—if he
should come to North Carolina—he
would see that the practices he began
in the sanatorium treatment of tuber-culosis
have become general; he would
find that North Carolina not only is
using his methods, but that it has in-vested
many thousands of dollars to
cut down the waitii:ig lists at oiu:
various sanatoria. If he should study
our statistics on tuberculosis, he would
find that, while tuberculosis killed 3,577
North Carolinians in 1916, it was re-sponsible
for only 543 deaths last year.
The death rate fell from 142.3 to just
13.0 for 100,000 population. That is a
large number, to be sure, but think
what the total would have been, with
our greatly increased population, had
the death rate remained what it was
in 1916.
If he should visit North Carolina
today, Trudeau would find Public
Health engaged in a mass x-ray sur-vey
in the State, to determine those
who are in need of the sanatorium
treatment, which he initiated, back in
those experimental days, when con-sumption
was considered an incm-able
disease. Furthermore, this great soldier
in the battle against "the great white
plague" would find that, already, chest
pictures have been made of nearly two
million persons fifteen years of age,
and older. The goal is an x-ray of the
entire population over fourteen.
The gains we have made have been
coincidental with the rise in the Amer-ican
standards of living, bearing out
Trudeau's findings that persons with
healthful surroundings who have fallen
victim to tuberculosis have a better
chance to recover. The rise in the
American standard of living has been
due, in no small part, to improvements
in the labor laws, which have brought
workers not only increased pay, but
shorter hours, enabling them to enjoy
more time in recreation and sunshine.
More money means more and better
food, more opportunities for the educa-tion
of the young, and better housing.
12 The Health Bulletin February, 1954
NOTES AND COMMENT
By THE EDITOR
The immunization status of the chil-dren
in any health department area is
at best difficult to estimate without
extensive survey techniques. The Dela-ware
State Board of Health has com-pleted
a state-wide survey which is
reported in a recent issue of the Dela-ware
State Medical Journal. The in-formation
gained during this survey
should be of interest to all physicians
and public health workers.
The returns were obtained from the
parents of some 2000 children born
between January 1, 1952 and April 30,
1952. At the time of the initiation of
the survey these children were from
8 months to one year of age. By the
time the survey was completed the
children were from 14 to 18 months of
age.
The significant results include:
72% of children had completed im-munization
again diptheria, whooping
cough and tetnaus given as triple
toxoid.
25% of children had been vaccinated
against smallpox.
3% had been immunized against
either diphtheria, whooping cough, or
tetnaus with preparations other than
triple toxoid.
Four infants were immimized by
private physicians for every infant im-munized
at a well child conference.
The well-child conferences immuniz-ed
chiefly children in the non-white
group.
Health officials in Delaware felt the
survey again emphasized the need for
continuing stress on the importance
of immunizations within the first year
of life.
4> * * *
Intestinal parasites are now consider-ed
by many as "nusiasance" diseases
and the lowly worm, once the cause of
sickness and disability for thousands, is
no longer thought of as a public health
problem.
Interesting in-sight into the preval-ence
of intestinal parasitism is given
by a recent report from the North
Carolina State Laboratory of Hygiene
on the incidence of stool specimens
found to contain parasites during the
period January through June 1953.
During the six month period, a total
of 10,121 stools were examined and
1,876 or 18.5% were found to contain
some type of parasite. These specimens
were received from 60 of North Caro-lina's
100 counties. Eighty per cent, or
about 1,500 of the positive specimens
contained hookworm. A total of 277, or
14.8% contained ascaris; 47 specimens
were positive for oxyaris, and 23 con-tained
E. histolytica. Some 41 speci-mens
showed evidence of multiple par-asitic
infestation with hookworm and
either ascaris, oxyaris or trichuris.
Fifty-six per cent of the positives
come from five North Carolina coun-ties.
New Hanover, Duplin, Hoke,
Cherokee, and Columbus.
Although these specimens were ob-tained
from individuals who were sus-pected
of having parasitic disease, and
do not represent a random sample of
the total population, they do indicate
a health problem of considerable mag-nitude
may be lurking imder our feet.
* * * *
VOMITING IN CHILDREN MAY BE
SIGN OF EMOTIONAL DISORDER
Vomiting may be the first and only
indication of an emotional disorder
in an infant or child, in the opinion
of Dr. Paul C. Laybourne Jr., Kansas
City, Kan.
"The infant has only a few ways in
which to express undue emotional ten-sion,"
Dr. Laybourne wrote in the
American Journal of Diseases of Chil-dren,
published by the i\merican Med-ical
Association. "He can refuse food,
cry excessively and vomit."
Much psychological vomiting in in-fants
and children is the result of a
disturbing atmosphere at home, Dr.
Laybourne pointed out, stating:
February, 1954 The Health Bulletin 13
"It is obvious in such cases that
direct treatment of the baby or child
is unnecessary. Psychological vomiting
in infants is easily diagnosed by the
simple expedient of hospitalizing them.
Almost universally the vomiting stops
with the removal of the baby from the
disturbing environment of the home.
This observation helps in making a
differential diagnosis between organic
and psychologic disease."
If no definite organic basis for the
vomiting of a baby can be established,
the emotional attitude of his mother
should be thoroughly investigated ac-cording
to Dr. Laybourne, as a severe
emotional disturbance in the mother
can be transferred to the baby.
"Just exactly how the psychic ten-sion
is transmitted to the child is
poorly tmderstood," he said. "If the
mother can communicate positive and
happy feelings to the baby by the tone
of her voice and expression on her
face, it would seem reasonable to as-sume
that disturbances in the mother,
I which produce tenseness and anxiety
i in her voice, as well as in her behavior,
I
can also be communicated to the
i child."
Treatment of babies whose emotional
I disorder is a reflection of that of their
parents' requires that the basic emo-tional
difficulty of the parents be re-solved,
Dr. Laybourne stated, adding:
"Any psychotherapy, therefore, is di-rectly
toward the parents and not the
child. If a successful resolution of the
parents' problem is impossible, the
child should be placed in a warm
friendly environment, so that it need
no longer react to the emotional
stresses of those who care for him.
Children up to the age of about five
years who have emotional vomiting
will respond satisfactorily to simple
environmental manipulation or psychi-atric
treatment of the parent."
As the child gets into the school
age or older, vomiting becomes more
difficult to treat, and combined therapy
of parent and child often is necessary,
he pointed out.
"Here the symptoms of vomiting may
appear less directly related to obvious
emotional disturbances in the parent,"
he added. "The vomiting often makes
its appearance following a traumatic
experience to the child, such as an
operation or infectious illness. In these
cases it would appear at first glance
that the operation or illness was the
'cause' of the vomiting. The operation
or infectious illness is only the trigger
mechanism setting off the reaction
which has been building up for many
months or years previously. The basic
difficulty is to be foimd again in the
parent-chUd relationship, and the ulti-mate
cure is brought about by correct-ing
the basic difficulties in the parent-child
relationship."
Dr. Laybourne stated that vomiting
in adolescents and adults also may be
a common symptom of an emotional
disturbance.
Dr. Laybom-ne is associated with the
departments of pediatrics and psych-iatry.
University of Kansas School of
Medicine.
* * * •
CARE AND PLANNING CAN
SALVAGE RETIREMENT
PRODUCTIVITY WASTE
With greater care and planning,
much valuable productivity that now
is being wasted by compulsory retire-ment
can be salvaged, it was stated
editorially in the Journal of the Amer-ican
Medical Association. Older work-ers
who are capable of and desire em-ployment
should be permitted to work,
it added.
As firms take great pains to choose
whom they will hire, there is no reason
why they should not concern them-selves
equally with the problems of
whom they will retire, the editorial
said. Retirement policies, in addition
to setting the conditions of retirement,
should state how older workers may be
profitably kept on the job and how
their status is to be determined.
The best way to determine who
should be retired, according to the
editorial, is for a firm to create a panel
to judge each case on its merits and
determine whether the worker should
continue in his present status, go on a
modified schedule, transfer to a less
14 The Health Bulletin February, 1954
demanding job, or be retired. The
panel, which should include one or
more high level executives and an in-dustrial
physician, should seek advice,
when necessary, from the employee's
immediate supervisor, the company's
personnel director, or the local union.
Restudying of methods of work and a
restudying of training methods also
wall aid in the solution of the problem,
it was added.
"In our aging population the gap
between retirement and death is
widening," the editorial pointed out.
"In 1900 it averaged about two and a
quarter years. This had doubled by 1950
and is still increasing. The reason for
this is a combination of two factors:
the saving of more lives between birth
and age 35, and the policy in many
firms of compulsory retirement at an
arbitrary age, usually 65.
"There is a growing recognition that
a fixed retirement age is ixnprofitable
for the employer, frustrating for the
emploj'ed, and eventually disastrous to
the national economy. Although some
workers become inefi&cient at 65 or
younger, a fixed retirement age works
a hardship on the productive majority
along with unproductive minority."
Although it is true that aging work-ers
suffer a gradual diminution in
strength and in the speed of their
muscular movements, these handicaps
are more than compensated for by an
increase in skill or accuracy and in
reliability and conscientiousness, ac-cording
to the editorial, which added:
"Many workers reach the age of 65
without showing any signs of slowing
up, and they should be allowed to do
some work. If the signs of aging are
beginning to become apparent, much
can be done to salvage the productivity
of the worker. A few who are out-standing
in production departments,
for example, can be taken off produc-tion
and made foremen or supervisors.
Others can be placed where the im-portance
of their increased acciuracy
outweighs the demand for speed.
"Anything that spares these workers
a feeling of frustration adds produc-tive
years to their lives. In some cases.
a worker can be kept on at reduced
hours or in work that is similar to his
usual tasks but less complex. Executives
and professional persons should dele-gate
part of their usual tasks to an
assistant.
"When a person reaches that stage
of life when a modification of his
activities becomes imperative, it is
sometimes wise or even necessary to
change over to an entirely different
type of work. If a person knows or
suspects that change to another type
of work is apt to become mandatory
at 60 or 65, he is wise to embark on
his second career a few years earlier,
because he is then In a better condi-tion
to learn his new duties and he
has a better chance of finding an
acceptable opening."
* * * *
DON'T GET YOUR VITAMINS
OUT OF A COSMETIC JAR
Alchemy makes alluring ads, but it
has no place on milady's dressing
table.
Vitamins have their place, but their
use in cosmetics may constitute a
health hazard, according to Mrs.
Veronica L. Conley, assistant secretary
of the American Medical Association's
Committee on Cosmetics. Writing in
Today's Health magazine, published by
the A.M.A., she stated:
"Prom time to time we hear claims
of something new and different in a
cosmetic. We are told that some prod-uct
is a panacea for wrinkles, crepiness
and other signs of aging. On the basis
of experience, most people view such
claims with a sophisticated eye. They
want more than an advertising claim
to be convinced, since even a quick
glance at the most faithful cosmetics
user is proof that skin aging proceeds
undisturbed.
"This is how we view the recently
revived and widely publicized vitamin-containing
cosmetics. A decade ago the
Federal Trade Commission ordered cer-tain
manufacturers to 'cease and desist'
from claiming that the addition of
vitamins A and D to cosmetics had any
beneficial effect on the skin. Therefore,
the reappearance of vitamin cosmetics
February, 1954 The Health Bulletin 15
about two years ago was the occasion
for some surprise."
During the last few years, Mrs. Con-ley
stated, much has been learned
about vitamins A and D—that they
are not always the good substances
that they were thought to be. Experi-ence
has shown that continued exces-sive
intake can cause serious reactions,
she added. Another important fact dis-covered
in recent years is that vitamin
A applied to the skin of animals causes
local thickening.
"Just what significance this has in
people must still be demonstrated, but
it does indicate that sufficient vitamin
A may cause skin changes," Mrs. Con-ley
pointed out. "Whether they are
good or not remains to be seen.
"The question then follows: 'What
does all of this mean in relation to the
daily use of vitamin A or vitamin A-D
creams over a long period?' The answer
is: 'We don't know.' In spite of this,
vitamin-containing cosmetics are being
promoted for use by the general public.
It is fair to ask whether cosmetics
are a rational place to use vitamins.
Serious vitamin deficiency is rare in
this country. So it cannot be assumed
that such deficiency is a common cause
of the universal skin-aging signs—dry-ness,
lines and wrinkles. There's no
good evidence that, in the rare case
where a deficiency does exist, vitamins
are more effective applied to the skin
than taken orally.
"Large oral doses of both vitamins A
and D are used successfully by physi-cians
for some pathologic skin condi-tions.
This situation is quite different
from the um-estricted application of
vitamins on apparently healthy skin
for beautification."
* * * *
ADDITION OF NUTRIENTS TO
FOOD BENEFICAL TO
NATION'S HEALTH
The addition of specific nutrients to
certain staple foods has been beneficial
to the nation's health and has en-couraged
sound nutritional practices,
the American Medical Association's
Council on Foods and Nutrition re-ported.
However, it stressed the desirability
of the individual meeting his nutri-tional
needs by the use of natural foods
as far as practicable. People should
learn, it was added, the proper choice
and preparation of foods, and better
ways to produce, process, store and
distribute foods.
The coimcil endorsed the enrichment
of flour, bread, degerminated corn
meal and corn grits; the nutritive im-provement
of whole grain corn meal
and of white rice; the retention or
restoration of thiamine, niacin and
iron in processed food cereals, and the
addition of vitamin D to milk, of
vitamin A to table fats and of iodine
to table salt.
"The principle of the addition of
specific nutrients to certain staple foods
is endorsed for the purpose of main-taining
good nutrition as well as for
correcting deficiencies in the diets of
the general population or of significant
segments of the population," it was
stated by Dr. James R. Wilson, Chicago,
secretary of the council.
"In order to avoid imdue artificiality
of food supply, foods chosen as vehicles
for the distribution of additional nu-trients
should be, whenever practicable,
those foods which have suffered loss in
refining or other processing, and the
nutrients added to such foods should
preferably be the kinds and quantities
native to the class of foods involved."
* * * •
NIGHT DRIVING HAZARDS
INCREASED BY TINTED GLASS
Use of tinted glass in automobiles
or the wearing of colored glasses for
night driving is dangerous because it
causes decreased visual efficiency, in
the opinion of Dr. Paul W. Miles, St.
Louis.
"Particularly imfortunate is the pop-ular
selection of pink for the glasses
and aquamarine green for the wind-shields,"
Dr. Miles wrote in Archives
of Ophthalmology, published by the
American Medical Association. "While
pure red and pure green filters may
be quite transparent, in combination
they are opaque."
Night driving is a similar visual task
16 The Health Bulletin February, 1954
to walking into a dark movie theater,
according to Dr. Miles. When a person
first walks into a dark movie theater
there is poor visibility of the seats
until the eyes have adapted themselves
to the dark although the screen can
be seen very well.
In night driving, every change from
light, such as headlights, to dark and
from dark to light requires a new
adaptation of the eyes. This adapta-tion
process is so slow that if it occur-red
in a dark movie theater the seats
forever would remain black again black,
just as the objects at a distance or
the shadows appear on the road.
"As the driver studies the road at
the distance limits of the headlights,
he constantly tests his visual thres-holds,"
Dr. Miles said. "Objects come
into view, attract attention, and are
finally identified, as the automobile
rapidly approaches. Under threshold
conditions, an image may form on the
retina (the part of the eye receiving
the image) 50 times and be so weak
that only 25 attention responses fol-low.
Any decrement in illumination or
visual eflaciency during high-speed
night driving could delay reaction
enough to result in a serious accident.
"Modern windshields were made
green because large areas of glass let
in too much heat from the sun. A
green filter cuts out the red and in-frared
rays which carry heat. For pur-poses
of night driving this windshield
color becomes the worst possible selec-tion
because automobile headlight is
unbalanced. Almost two-thirds of head-light
energy is concentrated in the red
end of the spectrum, and only one-third
is in the range to which a green
windshield is most transparent."
Tinted glass becomes even more
dangerous at night when headlights
are turned down or when the intensity
is diminished by mud or mechanical
defect, he stated. In addition, even the
slightest tinted glass adds to the night
visual problems of color-blind persons.
Dr. Miles pointed out that tests have
shown that visual acuity is markedly
decreased by the use of tinted glass
for night driving. Normal vision is
20/20. During night driving visual
acuity is 20/32 through colorless glass,
20/34 through light yellow glass, 20/40
through pink glass, 20/46 through green
windshield glass, and 26/60 through the
combination of pink glasses and a
green windshield.
"Even more damning is the effect of
tinted glass on resolving power during
night driving," he stated. "A pair of
objects which would appear separate
at 100 feet through a clear windshield,
would appear single through a green
windshield imtil the distance had de-creased
to 25 feet.
"Green windshield glass should be
in a separate layer, to be moved aside
for night driving. Persons with defec-tive
vision, including color blindness of
the common type, should be advised to
add auxiliary headlights to their auto-mobiles
and to avoid any type of
tinted glass for night driving."
Dr. Miles is associated with the de-partment
of ophthalmology and the
Oscar Johnson Institute of the Wash-ington
University School of Medicine.
* * * *
STUDY OF RELATIONSHIP OF
NOISE TO HEALTH URGED
Study of the relationship of noise to
health, especially in industry, and an
interpretation of the findings so that
management in industry and the public
can understand them, is needed, it was
stated editorially in the Jomnal of the
American Medical Association.
Most normal persons have a wide
adaptability to noise and once adapta-tion
to a given noise level is achieved,
energy is not expended by those work-ing
in such an environment at a rate
significantly greater than normal, the
editorial pointed out, adding:
"There are many reports claiming
that noise adversely affects public
health, but the possible relationship
between noise and health needs further
study. In viev/ of the problems related
to modern industry such study is now
in order."
DR. SYDENHAM B. ALEXANDER,
UNIVER3I1Y INFIRMARY,
CHAPEL HILL, N. C.
Putli5Ke(lI)vTflEMr/iamMSIMt)°AIi])^.qEALTA
1 TKis Buiieiin will be seni free to <n\\\ ciiizen of iKe Skite upon requcsi J
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912
Vol. 69 MARCH, 1954 No. 3
^^> ^
WILSON CITY AND COUNTY HEALTH CENTER
WILSON, NORTH CAROLINA
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
G. G. Dixon, M.D., President Ayden
Hubert B. Haywood, M.D.. Vice-President Raleigh
H. Lee Large, M.D Rocky Mount
John R. Bender, M.D Winston-Salem
Ben J. LavsTence, MJ) Raleigh
A. C. Current, D.D.S Gastonia
H. C. Lutz, Ph.G Hickory
Geo. Curtis Crump, MJD Ashevllle
Mrs. J. E. Latta HUlsboro, Rt. 1
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H., State Health Officer
John H. Hamilton, M.D., Assistant State Health Officer and Director
State Laboratorj' of* Hygiene
C. C. Applewhite, M.D., Director Local Health Division
Ernest A. Branch, D.D.S., Director of Oral Hygiene Division
A. H. Elliot, M.D., Director Personal Health Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
Fred T. Foard, M.D.. Director Epidemiology Division
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin, which will
be sent free to any citizen requesting it. The Board also has available for
distribution without charge special literature on the following subjects. Ask
for any in which you may be Interested.
Diphtheria
Flies
Hookworm Disease
InfantUe Paralysis
Influenza
Malaria
Measles
Scarlet Fever
Teeth
Typhoid Fever
Tjrphus Fever
Venereal Diseases
Residential Sewage
Disposal Plants
Sanitary Privies
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent free to
any citizen of the State on request to the State Board of Health, Raleigh, N. C.
Prenatal Care
Prenatal Letters (series of nine)
monthly letters)
The Expectant Mother
Infant Care
The Prevention of InfantUe Diarrhea
Breast Feedlnpr
Table of Heights and Weights
Baby's Daily Schedule
First Four Months
Five and Six Months
Seven and Eight Months
Nine Months to One Year
One to Two Years
Two to Six Years
Instructions for North Carolina
Midwlves
Your Child From One to Six
Your Child From Six to Twelve
Guiding the Adolescent
CONTENTS Page
Accidents As A Health Problem In North Carolina 3
What To Do During Mental Health Week 5
Notes And Comment 9
T^ST ^^ mm iBllPUBLISAED BYTAE N^A CAROLINA STATE BOARD-^AEALTA
Vol. 69 MARCH, 1954 No. 3
r. W. R. NORTON, M.D., M.P.H., State Health OflScer JOHN H. HAMILTON, M.D., Editor
ACCIDENTS AS A HEALTH PROBLEM
IN NORTH CAROLINA
By CHARLES M. CAMERON JR., M.D., M.P.H.
Chief, Accident Prevention Section
N. C. State Board of Health
A widely circulated standard Ameri-can
dictionary has defined an accident
as "an event that takes place without
one's foresight or expectation," how-ever,
experience has alerted health
workers to expect accidents to cause
over 2400 deaths in North Carolina
each year and to cause an estimated
240,000 persons to be permanently or
temporarily disabled.
While the accident to the individual
may be classed as an unexpected event,
the accident toU in the community may
be predicted with alarming accuracy
in terms of deaths, disability and eco-nomic
loss. Numerically, accidents are
ranked as the fourth leading cause of
death in North CaroUna and since
accidents claim their victims at an
earlier age than heart disease and
cancer, it is now considered by many
as the most important cause of death
from the standpoint of economic loss
to the state.
Credit for creating awareness to the
accident problem must go to those
active in the field of occupational
health for it was in this area that
the first steps were taken into the
reasearch, study, and action in making
the individual safety conscious .
With the advance of the motor ve-hicle,
much attention has been directed
toward accidents related to transpor-tation
and many agencies are now en-gaged
in full-time activities designed
to reduce the number of lives lost
on America's highways. Until the past
few years, little effort has been ex-pended
toward the prevention of the
accident in the home and on the farm,
an equally serious health problem which
was recognized by a few far-sighted
pubUc health workers as early as 20
to 30 years ago.
In North Carolina in 1952, all acci-dents
caused 2,492 deaths. Of this nimi-ber,
1,168 were associated with some
type of motor vehicle accident and
168 were caused by some other form
of transport vehicle. A total of 1,158
accidents were classed as non-trans-port
accidents. Of this latter niunber,
the largest single group, 618 fatal acci-dents,
occurred in the homes or farms
of the state. The remaining 540 deaths
were caused by accidents in public
parks, playgrounds, fields and woods
and other areas outside the home.
OflBcial records are available only
on fatal accidents, but the National
Safety Council, using figures obtained
from large scale household surveys,
estimates that for each fatal accident
there are from 100 to 150 non-fatal
accidents which result in disabiUty for
at least 24-hours. It is also estimated
that for each fatality, there will occur
The Health Bulletin March, 1954
four accidents which result in perma-nent
disability of some type.
Using the number of fatal home
accidents only as a base, then it be-comes
obvious that there were 60,000
home accidents in North Carolina
which disabled for at least 24-hours
and that North Carolinians were dis-abled
permanently at the rate of 2400
per year from home accidents in 1952.
Two other figures are available wliich
may help define the accident problem
in North Carolina. The North Caro-lina
Blind Commission has estimated
that about 19 per cent of their clients
are blinded due to accidents. The
Vocational Rehabilitation Division of
the Department of Public Instruction
has stated that accidents are the larg-est
single cause for referral to their
agency, accoimting for 25 per cent of
all injuries in which rehabilitative
services are rendered.
Due to the large number of organi-zations—
both public and private—who
are active in the health field, many of
whom moblize tremendous public re-lations
programs to obtain public sup-port,
it is difficult at times to obtain
an unbiased accoimting of the serious-ness
of any given condition as a health
problem. One should be aware that
home accidents in North Carolina in
1952 caused more deaths than did
poliomyelitis, tuberculosis, diptheria,
and the other major commmiicable
diseases combined.
The home accident is the only single
cause of death which ranks among the
leading seven causes of death for all
age groups. It is a leading cause of
death during the period from birth
through young adulthood and while
the home accident ranks as a lesser
cause of death in the older age groups,
the actual numbers of accidental deaths
remain large, but become only re-latively
less important as the incidence
degenerative diseases increases with
advancing years.
During the past two years, the local
health departments in the state have
cooperated with the N. C. State Board
of Health in the collection of epi-demiological
data related to fatal home
accidents. Health department staff
members have conducted on-the-spot
investigations into the circumstances
smrrounding home accidents which
terminate fatally. This data is now
being subjected to statistical analysis
and certain preliminary information
has been developed.
The North Carolina studies have re-vealed
that accidents are the greatest
threat to the very young and the very
old with 20 per cent of non-motor
vehicle accidents occuring to persons
under five years of age and 20 per
cent to persons over 65 years of age.
Falls, of all types both on the level
floor or ground, and from one level
to another as in the case of steps,
porches, and ladders, were the single
most important type of home acci-dents.
Falls caused 278 deaths in the
home in 1952. Over 60 per cent of
fall victiQis were over 65-years of age.
Fires, explosions, and conflagrations
were the second most frequent type of
home accident, causing 202 deaths.
About 40% of individuals killed by
fire in the home were under 10 years
of age and an additional 17 per cent
were over 65 years of age.
Accidents with firearms caused 65
deaths in 1952 and about 20% of these
deaths were in children under 10-years
of age. The "imloaded gim" remains a
serious menace in many North Caro-lina
homes. Poisons, both liquid and
solid, ranked as another important
cause of death in the home, accounting
for 41 deaths, over 50 per cent of
which occurred in children under 5
years of age.
If accidents are classed as "motor
vehicle" and non-motor vehicle," one
finds 1292 accidents in the latter cata-gory
in this state in 1952. A total of
903 of these accidents happened to
men while the weaker sex accounted
for 389 accidental deaths. The acci-dent
experience is higher for men in
every age group except the years above
65-years when more females were
killed than males. The calculation of
age-specific death rates which will be
included in the final tabvilatlon of
the 1952 data may show this differ-
March, 1954 The Health Bulletin
ence is not a true one.
Additional information relating to the
accident problem is now being develop-ed
and it is planned to make this
information available to interested
groups and individuals in the state as
the accident studies continue.
It is obvious that accident's repre-sent
one of the most serious health
problems facing the state today. From
the close relationship which pubUc
health departments enjoy with the
individual and his home environment,
it seems obvious that the prevention
of home accidents warrants the speci-fic
attention of the State Board of
Health and the local health depart-ments
in North Carolina. Important
in this connection is the fact that
public health workers are trained in
the fundamentals of disease preven-tion
and should be able to adapt these
principles to accident prevention.
The prevention of home accidents
has been categorized by public health
specialists as essentially a local health
department activity. The State Board
of Health can offer consultation and
assistance in planning an accident pre-vention
program, but the actual work
must be carried out at the local leveL
No one professional group in a health
department can be designated as solely
responsible for the accident control
activities. This activity must be re-garded
as a public health problem
requiring the efforts and cooperation
of every staff member. Such a program
to succeed must embrace the medical,
nursing, sanitation, statistical, educa-tional,
and other health department
personneL
The U. S. Public Health Service, a
health agency which has been active
in the field of accident prevention
for the past several years, has defined
the immediate objectives of health de-partment
workers as the elimination
from the home, so far as possible,
those conditions which cause accidents,
and the training of people to act in a
safe manner within the home environ-ment.
The very nature of the health
department's work with all ages and
all groups makes each staff member a
potentially potent force in the preven-tion
of home accidents.
WHAT TO DO DURING MENTAL HEALTH WEEK
By EDWARD S. HASWELL
Chief, Mental Health Section
State Board of Health, Raleigh, N. C.
Take a good look at your calendar.
Have you marked off the first week
of May—May 2-7? If not, do so—in
red too. For that is an important week
for you—the most important, I think.
It is MENTAL HEALTH WEEK.
You may disagree with me about
this. You say, "Why should I be bother-ed
about MENTAL HEALTH WEEK?
There's nothing wrong with my mind."
And, no doubt, you are right.
Probably you are physically healthy
too. But does that mean you will al-ways
stay that way? No necessarily.
For you know that you can still get
many different sicknesses and ailments.
Because of that, even though you do
enjoy good physical health, you are
concerned about it.
Probably you do evers^thing possible
to keep healthy. You eat the right food,
drink pasteiurized milk, get fresh air,
a certain amount of sleep, brush yoiu:
teeth, and, of course, you don't eat
spoiled food or drink impure water.
And if you do have an ache, a pain,
or a fever, you go to your doctor.
Well, that's the way it Is with your
mental heaJth. Just because you have
good mental health, doesn't mean you
will always have it. For you can get
all kinds of mental and emotional
6 The Health Bulletin March, 1954
sicknesses, the same as you can get
different physical ailments. So you see,
you should be concerned about your
mental health.
But, keeping mentally healthy, is not
altogether easy. For one thing, few
communities have mental health spe-cialists
to suggest ways of staying men-tally
healthy; few communities have
mental health specialists who can
help you regain your mental health if
you should begin to lose it. For frankly,
when it comes to North Carolina, it
just does not have enough mental
health specialists or facilities to give
you and yoiu: children and relatives
the best possible help when it comes
to mental health.
Yet, North Carolina does not have
to continue to go without these facili-ties.
You can do something about
changing this situation. So can your
relatives, your friends, your neighbors.
As a matter of fact that is why
MENTAL HEALTH WEEK should be
especially important to you. It gives
you a chance to do something about
North Carolina's inadequate Mental
Health facilities.
FOR MENTAL HEALTH WEEK is
not just a time for reading articles
or listening to radio programs and
speeches about Mental Health. It is
also a time for you to ask some
searching questions about your com-munity's
mental health facilities. For
instance, you might ask, "Could my
commmiity give help to someone like
Jim?"
Frankly, Jim is no one in particular.
He could be your doctor's, or minister's,
or teacher's, or neighbor's boy. He could
be yours. For Jim Is everywhere—in
every commiuiity. There are thousands
of Jims.
Probably he attends your local school,
though he isn't too happy about it.
No doubt, he plays hooky—probably
started truanting when he was rine
or ten years old. He's been in all kinds
of mischief too—stole a bicycle and
broke into a store. In so many words,
Jim is a delinquent.
That means something must be
wrong with him—he must be malad-justed
som

1
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of t^e
DltJi0fon of pzaitb affairs
canltjergitp of mom Carolina
)
This Book Must Not Be Taken
from the Division of Health
Affairs Buildings.
ThU JOURNAL may be kept out TWO DAYS,
and is subject to a fine of FIVE CENTS a day
thereafter. It is DUE on the DAY indicated
below:
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DR. v; R. BERRYHILL,
CHAPEL HILL. N. C.
I TKb BuUetm will be sehi free to anil citizen of ri\e Siate upon request i
Published monthly at the office of the Secretaiy of the Board, Raleigh, N. C
Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912
Vol. 69 JANUARY, 1954 No. 1
j^
CURRITUCK COUNTY HEALTH CENTER
CURRITUCK, NORTH CAROLINA
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
G. G. Dixon, M.D., President Ayden
Hubert B. Haywood, M.D., Vice-President Raleigh
H. Lee Large, M.D Rocky Mount
John R. Bender, M.D Winston-Salem
Ben J. Lawrence, M.D Raleigh
A. C. Current, D.D.S Gastonia
H. C. Lutz, Ph.G Hickory
Geo. Curtis Crump, M.D Asheville
Mrs. J. E. Latta HUlsboro, Rt. 1
EXECUTIVE STAFF
J. W. R. Norton. M.D.. M.P.H., State Health Officer
John H. Hamilton, M.D., Assistant State Health Officer and Director
State Laboratory of Hygiene
C C. Applewhite. M.D., Director Local Health Division
Ernest A. Branch, D.D.S., Director of Oral Hygiene Division
A H. EUiot, M.D.. Director Personal Health Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
Fred T. Foard, M.D., Director Epidemiology Division
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin, which will
be sent free to any citizen requesting it. The Board also has available for
distribution without charge special literature on the foUowmg subjects. Ask
for any in which you may be Interested.
Diphtheria Measles Residential Sewage
Flies Scarlet Fever Disposal Plants
Hookworm Disease Teeth Sanitary Privies
Infantile Paralysis Typhoid Fever Water Supplies
Influenza Typhus Fever Whoopmg Cough
Malaria Venereal Diseases
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent free to
any citizen of the State on request to the State Board of Health, Raleigh. N. C.
Prenatal Care Five and Six Months
Prenatal Letters (series of nine) Seven and Eight Months
monthly letters) Nme Months to One Year
The Expectant Mother One to Two Years
Infant Care ^^° ^° Six Years
The Prevention of InfantUe Diarrhea Instructions for North Carolina
Breast Feeding Midwives
Tahlp of Heiehts and Weights Your Child From One to Six
Bibv's Daily Iched^e ^ Your Child From Six to Twelve
First Four "Months Guidmg the Adolescent
CONTENTS Page
Public Health And The Private Physician 3
Fluoridation Of Public Water Supplies 8
Legal Problems Of Public Health 10
Notes And Comment 1^
w hmBm IPUBLI5MED BYTAE N^RTM CAROLINA STATE B*ARD«/AEALTA
Vol. 69 JANUARY, 1954 No. 1
}. W. R NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor
PUBLIC HEALTH AND THE PRIVATE
PHYSICIAN**
Obligations and Opportunities
JOHN R. BENDER, M.D.***
Winston-Salem, N. C.
As a member of the Board of Health
of Forsyth County and also of the State
Health Department, I have been aware
of the caustic remarks and unjust criti-cism
by laymen and professional col-leagues
alike, who, out of selfishness or
misunderstanding, have expressed the
backward views of short-sighted per-sonalities
rather than the long-range
vision of mature judgment. There are
few physicians in private practice who
are not alert to the need for improve-ment
in the treatment of individual
illness or injury, but entirely too many
overlook their opportunity for leader-ship
in planning efficient local health
centers, hospitals, and medical services
for their communities. When we physi-cians
fail to participate in community
health planning, we are neglecting our
civic duty; and those who assume this
responsibility as the result of our de-fault
may omit medical consultation
altogether when they undertake a pro-gram
of medical care. Inertia on the
part of physicians with respect to their
Reprinted from the North Carolina
Medical Journal.
**Read before the First General Session,
Medical Society of the State of North Caro-lina,
Pinehurst, May 12, 1953.
***Chairman of the Board of Health,
Forsyth County, North Carolina.
community responsibilities antagonizes
the public. The answer "too busy" to
attend the sick or to serve on boards,
health councils, and agencies becomes
a mockery when these "busy" physi-cians
are seen two or three afternoons
a week on the golf links. In order to
avoid indictment of our profession,
physicians must strive to maintain
good will in our respective communities
through a willingness to serve.
Definition and Objectives
The interrelationship between the lo-cal
health department, the practicing
physician, and the community can be
better understood if we analyze the
defintion of public health. The defini-tion
accepted by the United Nations
reads:
"Public Health is the art and science
of preventing disease, prolonging life
and promoting physical health and effi-ciency
through organized community
effort for the sanitation of the environ-ment,
the control of communicable in-fections,
the education of the individual
in principles of personal and com-mimity
health, the organization of
medicine and nursing services for the
early diagnosis and preventive treat-
The Health Bulletin January, 1954
ment of disease and for the develop-ment
of the social machinery which
will insure to every individual in the
commimity a standard of living ade-quate
for the maintenance of health."
Therefore, public health should be
considered an institution created by
society to protect and promote a state
of community well-being. We may also
accept the premise that through public
health each community should so or-ganize
its efforts as to enable every
citizen to realize his birthright of
health and longevity. It is in his local
commimity that the physician has his
greatest opportunity to become a states-man
in public health.
We must recognize the continuous
interacting relationship between the
practice of medicine and the social and
economic pattern of the community. It.
is here that many of our public health
problems exist. These social and eco-nomical
patterns create different prob-lems
in different commimities and
necessitate the many different divisions
in the structure of health administra-tion.
Regardless of diversified com-munity
problems, however, none of the
special divisions of health service
should enter fields which will create
friction in the structure of medical
care.
The object of public health is not
merely to prolong life, but to increase
the vigor, efficiency, and happiness of
all the members of our complex society.
This is no easy goal, and it has no ap-peal
for those who fear opposition or
criticism. Just as the function of the
practitioner is to cure for the individual
sick person, the fimction of public
health is to prevent illness in the com-munity.
Health oflBcers and private
practitioners realize that their duties
are the same—namely, the care of the
sick and the prevention of disease.
The basic principles of the American
Medical Association are: "To promote
the science and art of medicine and
the betterment of 'Public Health'." The
principal objectives of the U. S. Public
Health Service, the State Board of
Health, and the local health depart-ment
are the same. This unity of
thought and oneness of purpose has
created an endorsement, one for the
other. There is no conflict between
these agencies and private medicine.
It should be remembered that public
health is not limited to preventive med-icine,
communicable disease control,
santiation, or anything less than the
promotion and attainment of better
community health. To attain this goal,
we must use our vast knowledge and
skill for the prevention of disease. The
commimity must rely upon its local
health department for the diagnosis
and treatment of its various ills. A few
community problems which come under
the specialized care of the community
doctor—the board of health—are en-virormiental
sanitation, rodent control,
sewage disposal, stream pollution, pas-teurization
of milk, inspection of food,
maternal welfare, accident prevention,
and many others. Each of these prob-lems
is directly concerned with the pre-vention
of disease and the betterment
of the community. The task requires
the full utilization of all available pro-fessional
knowledge and skill; and, far
from giving rise to conflict, should
create the closest unity between the
local health department and the pri-vate
practitioner.
The Health Department
—
Administration
The health of any community with
a local health department rests upon a
tripod—namely, the health department,
the practicing physician, and the pri-vate
citizen. The health department,
under the local health ofBcer, is the
administrator of such community assets
as federal and state funds, grants, gifts,
fees, taxes, appropriations, and so forth.
This supportive leg of the tripod, which
I choose to speak of as administrative,
is closely associated with the various
communities of the county health dis-tricts,
and the health officer acts as
liason between the individual citizen
and his county board of health, the
State Board of Health, the federal
government, and the U. S. Public
Health Service. This administrative leg
was created by legislative action, first
January, 1954 The Health Bulletin
in the establishment of a State Board
of Health and later in the establish-ment
of local boards.
Power delegated to the local boards
of health through constitutional and
statutory authority gives the health
department of each county or health
district local autonomy. The authoriza-tion
reads:
"The County Board of Health shall
have the immediate care and respon-sibility
of the Health interest of their
County. They shall make such rules
and regulations and impose such pen-alties
as in their judgment may be
necessary to protect and advance the
public health."
This sweeping grant of power to legis-late
in health matters gives the local
health department autonomy which is
respected by the courts so long as it
does not run counter to state and
federal constitutions and statutes. With
this delegated power goes the respon-sibility
of each physician in the com-munity
to analyze local situations as
they arise. Where conflicts or friction
exist they should be met with an
honest, courageous, objective approach,
with a sharing of responsibilities and a
mutual confession of errors. The
achievement of our purpose—to protect
and advance the public health—does
not require all sweetness and deference,
for such an attitude or purpose would
be worse than no purpose at all. Only
in honest disagreement, provided it
does not reach the point of stifling the
effectiveness of the health department,
will the department grow, develop and
move forward.
The Private Physician—Construction
This bring us to the second support
of the tripod, which I propose to call
"construction." The practicing physi-cian,
through membership in his coun-ty
medical society, State Medical So-ciety,
and the American Medical Asso-ciation
is the main pillar of support.
This affiliation brings together the
physician in private practice and the
physician in public health in a fra-ternal
association. It provides social
relationships, one with the other, and
affords an opportunity for critical ex-amination
of the strengths and weak-nesses
of physicians in various fields of
practice. Each particular field deserves
and should enjoy the confidence and
respect of the others.
The private physician is trained to
diagnose and treat individuals, but he
is not trained or experienced in treat-ing
the body politic—the whole com-munity.
This body politic can be treat-ed
definitively only by a team of pro-fessional
health workers, engineers,
sanitarians, health nurses, technicians,
clerks, and others working together. To
delegate to or expect from the private
physician definitive treatment of civic
ills is failing the commimity and ag-gravating
any conflicts which may exist
between the physicians and the health
ofiBcer, as well as leaving the medical
profession vulnerable to attack by those
who wish to vilify our system of prac-tice.
The health department affords the
best single public relations medium the
medical profession can develop. An
active committee in each county med-ical
society is needed for consultation
with the local boards of health and
health departments. Such a committee
will make sure that our health services
are kept in useful fields. It is time for
us to take inventory and make a care-ful
appraisal of our services versus our
present needs, and also to plan dis-creetly
towards the needs of the future.
The Private Citizen—Unified Action
This brings us to the third support of
the tripod—the one which I call "Uni-fied
Action." Without the former sup-ports—
administration and construction
—the system of cormnunity health
would fail. Without a third support,
the other two would become ineffective.
While the health officer and private
physician are indispensable, the actual
working power should be drawn from
the citizens of the community. Such
power can be obtained only by coordi-nating
the efforts of the private physi-cian
and the public health practitioner.
The American people are greatly in-terested
in the alleviation of human
suffering, in the social implications and
economic penalties of disease, and in
The Health Bulletin January, 1954
the improvement of Man's lot through
preventive medicine and public health.
The public concept of disease has
changed from regarding it as inexor-able
fate or the wages of original sin
to tangible enemies which can be de-feated
by proper organization and
financial support. This change of atti-tude
has created a public demand from
which the physician and health oflBcer
cannot escape, lest by public pressure
and political power they find them-selves
subservient to bureaucracy.
The principal health need of any na-tion
as socially, technically, and scien-tifically
advanced as ours is an instru-ment
that will offer an intimate, per-sonal
service to which individuals can
turn for assistance and guidance, in
times of physical and mental distress,
and a basically sound diagnostic and
therapeutic service that will assure the
individual a good first line of protection
against the common hazards of illness
and injury. To a large degree—cultural-ly,
and in private practice—the family
physician is this instrument; therefore,
the health needs of a nation depend
upon the success or failure of the prac-ticing
physician in discharging his re-sponsibilities.
Loss of Confidence Despite Progress
I am aware of the remarkable prog-ress
made within the life span of this
generation, and I am also aware that
medical science is progressing at an al-most
unbelievable rate. Approximately
80 to 90 per cent of the therapeutic
agents and diagnostic tests which are
considered routine today were unheard
of or regarded as rarities a decade ago.
As these therapeutic adjuncts have
emerged from the laboratories to the
field of everyday practice, the health
of the community has proportionately
benefited.
More notable, however, than the re-cent
progress made in medical and
surgical techniques and immvmizations
has been the advance in environmental
sanitation, insecticides, nutrition, hos-pital
construction, economics, screening
tests, and mass surveys for early case
finding. The medical profession today,
as never before, is seeking better health
care for its people through continuous
research, improved methods of sanita-tion,
more careful inspection, stricter
enforcement of the Pure Food and Drug
Act, and many other day to day serv-ices.
The citizens of America enjoy the
best medical care of any country of the
world. The system of American medi-cine
is the best the world has ever
known, and the American Medical As-sociation
is acclaimed the medical lead-er
of the world. In spite of its record
of service, however, this system, which
is the best to be found, and which con-tinues
to get better, is being vilified by
those people to whom it is giving so
much.
Why?
I do not have all the answers for all
the whys, but I think we can find
many of the reasons from a statement
which appeared in an editorial in a
metropolitan newspaper several months
ago! "Many a man frankly doesn't
care whether the efficient machine in
the white coat is socialized or not, be-cause
he feels the machine doesn't give
a damn about him."
We should read in this not an atti-tude
of belligerence, but a disturbed
concern over the loss of confidence in
the American doctor. As the third sup-port
of the tripod, the private physician
has an opportunity to restore public
confidence in American medicine. We
have lost such confidence because we
who are presumably above the average
in our community, with superior train-ing
and unquestionable standing, have
failed to play our proper role as private
citizens.
The Fault and the Remedy
Why do medical men default in their
responsibilities as citizens? Is it because
we have concentrated on the scientific
aspect of medicine and lost touch with
the social, economic, and political reali-ties
of today? Has our scientific growth
isolated us from the complex problems
of modern civilization? As a result of
superior training and endowment, prac-ticing
physicians today should play a
major role in the affairs of the county,
January, 1954 The Health Bulletin
state, and nation. This we must do if
we are to retain our freedom not only
in medicine, but in our way of life.
As practicing physicians, we must
concern ourselves with the following:
1. We must keep flowing a never-ending
stream of scientific and techni-cal
advances in medicine, in order to
give our patients the best possible med-ical
care. The patient's right to skilled
medical care must always be respected.
There must be absolute teamwork and
liaison between the practicing physi-cian
and the various health agencies.
2. We must concern ourselves with
the economic, social, and political
aspects of medical care as it involves
the present and futvu-e welfare of the
American people. The patient's welfare
must always be our primary objective.
3. We must approach the futvure with
a keen insight into the new problems
which have been created by the rapid
progress of medicine. The prolongation
of life has produced the new problem
of finding ways and means to prevent
and control the degenerative changes
leading to chronic illness. The length-ened
life span has resulted in an ever
increasing burden of human suffering
attendant upon the vicissitudes of old
age and economic strain. If we aid
people by adding more years to life, we
must also aid them by adding more
life to years. As citizens we should use
our influence and knowledge in help-ing
to improve the attitude of industry
toward employing older persons and in
getting insurance companies to extend
medical coverage to protect the added
years.
A community, like a private business,
needs to talk out its problems. The peo-ple
need to imderstand what goes on
above and below the range of their im-mediate
vision. They need to under-stand
the complexity of their com-j
munity problems and the over-all effect
of these problems on their environ-ment,
their economy, their livelihood
• and their health, and to develop an
over-all program. Our task in such a
program is to make known the answers,
,' through community education and the
: promotion of soimd voluntary health
insurance plans. We see in this that
the solution of our main problems, as
an integral part of our community wel-fare,
through the thu-d leg of our tri-pod
is: (1) an atmosphere of friendly
understanding and health education
between doctors and the general public;
(2) recognition that the doctor of medi-cine
exists for the benefit of the people
and not for the benefit of the profes-sion;
(3) recognition that medicine is
a social as well as a biologic science;
(4) recognition that it is necessary as
never before for the private physician
to discharge his responsibilities as a
citizen.
Conclusion
The task of the future carmot be
solved by formulas alone. We must be
wise and understanding as well as
courageous, and as professional men
dedicated to the saving of human lives,
we must be willing to leave the direc-tion
of hvunan affairs to those who be-lieve
in duplicity, dishonesty, or force.
Leadership in moral responsibility is
sorely needed, and recognition of this
need will be the beginning of our reali-zation
that something must be done.
We must take every opportunity to
bring a knowledge of moral responsi-bility
into every facet of commimity
life. Our best friends in any community
are our patients who look to us as
leaders. We should take advantage of
this close, personal association to teach
them their moral responsibilities and
to show them that the health of a na-tion
rests on the health of its indi-vidual
citizens.
In order to have a healthy and
strong nation, we must be healthy and
strong ourselves. Reforms must come
from within and not from without.
When we see ourselves as private citi-zens
as well as physicians, and as an
integral part of our cormnunity, we
will then acknowledge our responsi-bilities
and lead others to do the same.
The community, the health service, the
social and economic structure of gov-ernment
will then reflect the honestry,
integrity, and ability of our profession.
We should remember that medical
men in the past won their standing,
8 The Health Bulletin January, 1954
not as scientific machines, but as sym-pathetic
and understanding human be-ings,
and we should obey His command,
"Go Ye and Do Likewise."
FLUORIDATION OF PUBLIC WATER SUPPLIES
By ERNEST A. BRANCH, D.D.S.
The Council on Dental Health of the
North Carolina Dental Society is spon-soring
this series of articles on Dental
Health. The writer, Dr. Ernest A.
Branch, is the Director of the Division
of Oral Hygiene of the North Carolina
State Board of Health.
Present Status of Fluoridation
The current state of fluoridation can-not
be termed the status quo, in the
popular use of that term, for it is con-stantly
changing. Fluoridation is a go-ing
concern with each week, even each
day, showing more and more evidence
in its favor and phenomenal gains in
its acceptance as a preventive measure.
From figures released November 1, 1953,
we find that in the Nation 15,914,227
people in 833 communities are drinking
fluoridated water. To this number will
be added 14,749,994 citizens of 366 com-munities
in which fluoridation has been
approved. The figures for North Caro-lina
show that fluoridation is in opera-tion
in 20 mimicipalities serving 513,620
people and that it has been approved
in 7 more towns with a combined popu-lation
of 146,797. In our State, then,
more than 660,000, or approximately
one-sixth of the population, will soon
be using fluoridated water. These fig-ures
do not include the 3,000,000 people
in the United States and an appreciable
number in North Carolina who have
been drinking water containing nat-urally
borne fluorides all of their lives.
It might be well to define the term,
fluoridated water. It is water to which
a small amount of a fluoride salt, a
natural constituent of water, has been
added in order to supply the deficiency
and bring the content to a certain
level which has been found to be bene-ficial
in reducing the incidence of tooth
decay. The generally accepted amount
is one part per million. This is such an
infinitesimal amount that a person
drinking 8 glasses of water a day for
16 years will consiune only an ounce.
We believe that the fact that many
water supplies are deficient in this
natural element is to be accounted for
through soil erosion. The fluoride salts
which are added to water are the same
ones which occur naturally. It will be
seen, then, that fluoridation is a matter
of nutrition and not medication. Add-ing
fluorides to water is comparable to
fortifying flour, that is, returning to
reflned flour the minerals and vitamins
which were taken out during the mill-ing
processes.
Last month we cited a few of the
many pilot studies in fluoridation.
There are now, as there have been for
years, many groups of physicians, den-tists,
bio-chemists, and other scientists
devoting much time and thought to
this fleld of research. The average citi-zen,
or even dentist, does not have the
time or the training in research tech-niques
to read and evaluate the vol-uminous
reports of the various studies,
experiments, and tests in order to de-cide
for or against fluoridation. As in
many other matters pertaining to
health we must rely on authoritative
sources for information and advice. Of
course, we should be certain that our
sources are authoritative.
Fluoridation has the backing of an
impressible array of scientific organiza-tions.
Among them are the following
groups with the dates of endorsement.
State and Territorial Dental Health
Directors, June 8, 1950
American Association of Public Health
Dentists, October 29, 1950
State and Territorial Health Officers,
November, 1950
January, 1954 The Health Bulletin 9
American Public Health Association,
November, 1950
United States Public Health Service,
April 24, 1951
North Carolina Dental Society, May
1, 1951
National Research Council, Novem-ber,
1951
American Medical Association, De-cember,
1951
The unqualified endorsement of these
societies and associations should assure
even the most faint hearted and cau-tious
that fluoridation is a safe and
effective public health measure. North
Carolina communities were "not the
first by whom the new was tried." We
hope they will not be "the last to lay
the old aside."
Fluoridation is a Community
Responsibility
In the discussion of the present status
of water fluoridation we listed some of
the National and State dental, medical,
and public health organizations which
have approved this preventive measure.
To this list may now be added the
American Academy of Pediatricians.
The recent endorsement of this group
of specialists in child health brings
added reassurance of the safety and
effectiveness of the fluoridation of com-munal
water supplies for the reduction
of the incidence of tooth decay.
As typical of the recommendations of
the several groups, we quote the one
adopted by the State and Territorial
Dental Health Directors.
"Resolved, That the State and Ter-ritorial
Dental Health Directors recom-mend
the fluoridation of public water
supplies for the partial control of
dental caries, where the local dental
and medical professions have approved
this program and where the community
can meet and maintain the standards
required by the State health authority."
This brings us to the procedure to
be followed by a communtiy wishing
to join the ranks of the 833 cities and
towns now adding fluorides to theii*
water supplies. First of all, it should be
understood that fluoridation is always
initiated locally. It is never imposed
on a community by a state or federal
agency. However, there are certain safe-guards
which have been included by
the North Carolina State Board of
Health in its policy which approves
and recommends fluoridation. These
requirements, in short, are: (1) that
the measure must be endorsed by the
local dental and medical societies, by
the local Board of Health, and by the
municipal governing body; and (2) that
the procedure for adding fluorides to
the water supply must comply with
standards established by the State
Board of Health.
The flrst move toward fluoridation in
a community may be made by any local
group, such as civic club or a parent-teacher
association. Information and
assistance may be secured from the lo-cal
dental society and health depart-ment,
as well as from the State Board
of Health and the State Dental So-ciety.
Of course, a preliminary step is
to determine the natural fluoride con-tent
of the water supply to find whe-ther
or not the addition of a fluoride
compound is indicated.
A matter of interest is the cost of
fluoridation. This is effectively answer-ed
in the title of a booklet by the
Public Health Service, "Better Health
from 5 to 14 cents a year through
Fluoridated Water." This represents
the per capita cost of the equipment,
amortized over a 20 year period, and
the yearly supply of the fluoride com-pound.
The three compounds generally
used are sodium fluoride, silicofluoride,
or sodiimi silicofluoride.
In conclusion, two reminders are In
order. For the first we quote a para-graph
from the above mentioned pub-lication.
"To gain the full benefits of fluori-dated
water, children must drink it
during the period their teeth are form-ing,
or from birth to about age 8.
Children who are older at the time
fluoridation is started receive some pro-tection
against dental decay, but not
as much as the younger children. The
protection obtained by children con-tinues
throughout life."
10 The Health Bulletin January, 1954
For the second reminder, we call
attention to the phrase in the resolu-tion
by the State and Territorial Den-tal
Health Directors, "for the partial
control of dental caries." The fluorida-tion
of water supplies is not a "cure-and
there is no evidence that it will
retard dental decay that has already
started.
"Visit your dentist" is still the most
important dental health rule. Regular
dental care is essential to good dental
all." It does not prevent all tooth decay health.
LEGAL PROBLEMS OF PUBLIC HEALTH
WILLIAM McW. COCHRANE, Assistant Director
Institute of Government
Chapel Hill, N. C.
It may be helpful, briefly, to trace
the history and pattern of health legis-lation
in North Carolina, as an aid to
understanding why our health laws and
regulations need attention today. The
first substantial piece of health legis-lation
applicable to the territory which
was later to become North Carolina,
was enacted in 1712 by the General
Assembly of the Province of Carolina.
It was entitled "An Act for the More
Effectual Preventing of Contagious Dis-temper."
It was, of course, a lifetime
quarantine law and it appointed a
Commissioner of Health for the pur-pose
of inquiring into the state of
health of persons arriving on vessels
into the ports of the province. At
that time the main port was Charles-ton,
but it also applied to the other
minor ports, minor at that time, but
lately becoming more important, which
were located in North Carolina.
In the 241 years between the General
Assembly of 1712 and the General
Assembly of 1953, literally himdreds of
pieces of health legislation have been
spread on the Statute Books of North
Carolina. Most of them were aimed at
the more effectual preventive of one
or another of the myriad of threats to
the public health which existed then
and exist now. In terms of sheer vol-ume
and number, however, compara-tively
few of our statutes enacted prior
to the Civil War had anything at all
*Read before the North Carolina Public
Health Association at Nags Head, N. C.
September, 1953.
to do with health. The statutory situa-tion
in 1854 illustrates this point. There
were very few statutes at that time on
our books having anything to do with
health. By that time though, there were
brief statutes for quarantine on ships
and in incorporated towns; in cases of
smallpox and other infectious diseases
there were rudimentary statutes. And,
they applied only after the situations
had gotten pretty bad; they weren't
very effective as preventive measures.
There was a statute providing for a
limited and very interesting meat in-spection.
There was one declaring stag-nant
water, dead animals, privies,
slaughter houses, and some objection-able
substances to be nuisances in sea-port
towns, even though some of those
things were necessary, they were nuis-ances
if they were not properly con-structed.
But, this statute didn't apply
to inland towns; there was no protec-tion
anywhere except in the seaport
towns. There was a statute providing
for the control of disease in cattle
which relied on a very ingenuous de-vice,
I don't know how well It worked.
No cattle could be transported from
place to place in this State without a
certificate to the effect that the cattle
were free from disease, and this certi-ficate
was a written statement to be
signed by any two Justices of the Peace.
The law also frowned on putting poison
in a neighbor's well, made it a mis-demeanor
to do that; it made the own-er
of a dog liable if the dog became
mad and bit someone else. And, that
January, 1954 The Health Bulletin 11
was the beginning of our Rabies Sta-tute.
All together, the state-wide Sta-tute
Laws, of North Carolina on the
books in effect for the protection of
public health at the time of the Civil
War could have been put on about 3
or 4 printed pages. By any standards,
the law offered very little more than
fragmentary protection to the public
health of the citizens of the time. Now,
it is familiar learning to you people in
public health what happened in public
health in the years immediately follow-ing
the Civil War.
During the next two decades after
that time, the State Boards of Health,
in roughly the modern pattern, were
established by statutes throughout the
country in a number of states. And
North Carolina followed suit with your
own State Board of Health with a sta-ture
enacted in 1877. This statute
designated the whole membership, the
entire membership of the State Medical
Society, as the State Board of Health,
and it was to act through a committee
which had an annual appropriation of
SlOO to carry on its work. Two years
after, this arrangement was terminated
by a statute which created a 9 member
board of health in the modern pattern,
which would be a regular department
of the State Government. However, it
wasn't until 1911 that the Board ac-quired
the services of the first full-time
administrator, the State Health
Officer, and began the development of
the modern agency staffed by pro-fessional
men and women working un-der
the general directions of the Board
of Health. This pattern of statutory
development of organized public health
work at the State level was very similar
to the development at the local level.
It is true that town government from
earliest colonial days had to concern
itself with threats to the community
health, and had to take action. The
action was usually emergency action
and was not often preventive, prospec-tive,
regulative action. But, it is also
true that organized health work under
the statutes in the modern sense at the
local level largely during the period
since the Civil War, was under a sta-tutory
pattern paralleling that of State
health work. North Carolina's first sta-tute
providing for a state-wide system
of county boards of health was enacted
in 1879 when the legislature decreed
that each coimty should have a county
board of health composed of the entire
membership of the county medical so-ciety,
plus the Chairman of the Board
of County Commissioners, the Mayor of
the county-seat town, and for some
reason, no reflection on the gentleman,
the county surveyor. I suppose his
familiarity with the conditions out in
the county accounted for his being on
that early board ... he was surveying
farms. This board was as unwieldly for
administrative purposes, as you can
readily see, as the original State Board
had been. And like the old State Board,
the 1879 county board functioned in
practice as something on the order of
a medical vigilante committee, organ-ized
to deal with epidemics, nuisances,
and similar urgent threats to the com-munity's
health, usually after they had
already begun rather than as an agency
administering the laws and regulations
aimed at preventing such disasters. Ac-cordingly,
such regulations as were
adopted by the county boards of health
in those days were mostly emergency
measures, to deal with urgent situa-tions.
And there were a few instances
of prospective and general preventive
rule making or regulation making.
There were a few cases that reached
the Supreme Court involving these
boards during those years, and they
illustrate the emergency or negative
nature of their work. Most of these
cases were cases upholding the power
of these boards to remove smallpox
victims to the county pest house. You
might say that a pest house was the
health center of its day, a far cry from
what, fortunately, we are coming to
see in North Carolina today.
It was in 1911, as most of you know
or have heard, that the county board
of health statute was first expressed in
substantially its modern form, with a
seven member board composed of both
lay and medical members. However, for
most of the State's counties this formal
L
12 The Health Bulletin January, 1954
statutory change had little immediate
effect on the type of health work which
was being locally administered. The
reason for that was simple, there were
no full-time health departments in the
counties and the change in the Statute
Law did not bring them into being, as
by a magic wand. In 1911 the only
county health department in the State
was Guilford, which was established in
that year. And, it was not until 1949,
I understand that the State reached
the 100% mark in that respect . . . full
time local health services.
Now a word about the cities and
towns during this long period. Incor-porated
municipalities in North Caro-lina
have had explicit statutory au-thority
under the General Law since
1893, and under particular town chart-er
provisions since Colonial Days, to
tax and spend, to adopt regulations,
and to impose penalities in the interest
of the public's health. They have what
is called plenary power, as do the
county boards of health. But, except
in a few instances, in a few of the most
popular centers, in largest cities, and
very few, most of the State's incor-porated
mimicipalities have left organ-ized
health work to the counties and
to the districts today. This is reflected
in the Statutes. Since 1877, the statu-tory
emphasis has been on the county
as the local unit for health work and
since 1935 this development has been
extended, as you know, under a statute
of that year, authorizing the creation
of multi-county, district boards of
health, with district health depart-ments
working under the district boards
of health. As the legislature gradually
worked out the statutory pattern of
State and local governmental machin-ery
for public health work, dm-ing this
roughly 50 year period following 1877,
it was also adding with each biennial
session to the collection of health laws
to be enforced by these agencies.
Now these additions to the Statute
Laws to date, these health statutes,
were often hard won victories, they
represented hard won victories after
long struggles in the legislative halls.
And, accordingly, often today they re-flect
the patchwork quality of legisla-tion
which is enacted as the fruit of
compromise between opposing factors.
Now, that is a process we are familiar
with, and it is a necessary process in
a democratic, representative govern-ment.
But, the result sometime is, and
it is the result in the case of some of
our health education that "like Topsy
it just grew." Sometimes a new statute
would be added without much refer-ence
to other statutes affected by the
new statute . . . the relationship wasn't
followed through, they didn't fit to-gether
properly, it was a patchwork
proposition, therefore, necessitating a
great deal of interpretation by the
health agents who are attempting to
enforce it and eventually by the lawyers
and the courts when things get a little
rough. By the late 20's I think it is
safe to say that most of this collection
of health laws was in its place on the
Statute Books of our State. Since that
time, relatively few changes have been
made over the last quarter century,
compared with the bulk of statutes
which are in effect today, which are
now older than 25 years. There have
been changes in every legislature, but
I mean the total bulk of the statute
law is older than a quarter of century.
And this same quarter of a century has
seen greater advancement of the activi-ty
of organized public health agencies
than they enjoyed in all their years be-fore
combined. There has been change
in the nature as well as growth in the
volume of organized public health work.
Public health is today defined much
more broadly than it once was, you all
know that. The coiu-ts are finding it out
on occasions. Health agencies have long
since extended their work, their sphere
of activity to include such vital con-siderations
of modern health, new con-cepts
to some of the people, but none
the less recognized as vital, as I under-stand
it, by you people, in increasing
degree. Such consideration as preven-tion
of occupational diseases, preven-tion
of accidents, elimination of slums,
elimination of bad living conditions,
looking at the total environment of the
citizen in your health work. The
January, 1954 The Health Bulletin 13
statutes have not kept pace with those
attitudes, they don't reflect them. They
reflect the traditional services which
you render. They are full of communi-cable
disease control and that sort of
thing which we have come to take for
granted as part of public health work.
A layman, a lawyer looking at what
you all are doing and looking a little
bit at the history of health work, as
one of those people, I am impressed
with this, that the expanded program
of State and local health departments
in North Carolina now flourishing here
would probably have seemed but an
irridescent dream. Twenty-five years
ago, no longer than that, in any coim-ty
in this State in terms of program,
in terms of money, in terms of staff,
the development has been enormous.
But during this same period, both State
and county boards of health have gone
through a transition from the stand-ards
of merely nominal regulation
making bodies . . . that is they had
the power to make the regulations but
it was for all practical purposes a
nominal power because it was not
broadly exercised and there were no
staffs to enforce the regulations which
were made . . . that is large staffs . . .
they have gone through this transition
from that status to the standards of
very active regulation making and
regulatory bodies, with large full-time
staffs, enforcing standards and regula-tions
which affect the interests, some-times
adversely when money has to be
spent, but affect the interest of an
increasing number of citizens in their
homes, in their businesses, and in their
persons ... for example the venereal
disease control statute. Property and
personal rights are affected to a much
greater degree than ever was the case
before in this field. And in this great
expansion of regulation and admini-stration
the process of improving the
techniques of the health sciences has
obviously far out stripped the process
of improving the health statutes, the
regulations and the legal and admini-strative
procedures of enforcement.
Public health personnel today, Univer-sity
trained in their specialities for
the most part, possessing the technical
knowledges and skills which they need
to protect and advance the public
health are not so well-equipped when
it comes to the legal aspects of their
work because of these things I have
mentioned. They don't find either quick
or clear answers to questions about
their powers and duties in their every
day work by looking for those answers
in the Statute Books. The result is that
often you have to play by ear rather
than by note because the notes aren't
there . . . certainly they are not easy
to find if they are there. I think that
most of us would agree that our statu-tory
provisions . . . praiseworthy though
they were at the time they were en-acted,
victories though they represent-ed,
pioneering efforts though they were,
are often full of meticulous details
about inconsequential or obsolete mat-ters
which aren't important any more
in public health. And, then they are
silent as the grave sometimes on mat-ters
which are widely recognized as
being vital parts of health department
programs. And, the statutes are more
than that, they are frequently am-biguous
and contradictory in many
places to the point of utter confusion.
For example, you are familiar with one
. . . one statute provides that the
county health oflBcer shall serve as
coimty physician, and another says he
may serve as county physician. The
practical effect of that, of course, is
to leave the decision with the county
board of health as to whether he shall
or shall not serve as county physician.
This same general comment can often
also be validly made about the regula-tions
made by our boards of health.
These regulations are often too hasted-ly
drawn, and usually unpublished, and
not always kept up-to-date, and they
are sometime inaccessible for all prac-tical
purposes not only to the public,
the citizens, but often even to health
department personnel. Now, you under-stand
that most of these things are
drawn by lawyers, of which I am one,
and it is not a matter of criticism
of anybody for the condition. These
are things that have just let slide over
14 The Health Bulletin January, 1954
a long period of years, and I think
that the major reason has been that
in health work, you emphasize persua-sion
and education and you don't go
to court until you have to. I think
that is the wisest thing in any law
enforcement program that I am fami-liar
with. The interesting thing is that
it works more effectively in public
health than it does in many others.
Prosecution seems to be necessary in
enforcing the general criminal laws of
the State. But in these circumstances,
it is not surprising that sometimes a
health officer or other health officials
or a sanitarian may discover that he
has been adhering to accepted sani-tary
or health standards and enforcing
them, only to find in court that the
regulations which he may have been
relying on have never been properly
expressed or adopted by a county board
of health and are, therefore, not valid.
I am sure you are all familiar with
examples of that situation. I certainly
have had enough conversation with
health officers and sanitarians to as-sure
me that that is widely the case.
Poorly drawn statutes and regulations,
of course, are not the exclusive pro-perty
of public health agencies. Justice
Harland Stone, of the Supreme Court
when he was Attorney General de-scribed
the general situation in these
words, "We make a prodigious number
of laws, in enacting them we disregard
the principles of draftsmenship and
leave in uncertainty their true mean-ing
and effect." I think if somebody
gave a committee here the power to
do nothing except go through all of
our health laws and repeal anything
this committee wanted to repeal, with
no power to add a line, we could prob-ably
come out with a better set of
regulations than we have to start with.
Certainly we could eliminate some con-flicts
that way. So the problem is not
more law, in fact it may very well be
that a properly drawn health code for
North Carolina would be a much
shorter thing and certainly a better
organized thing than our present
health statute. Alexander Hamilton had
a comment along the same line which
pointed to the dangers inherent in
confused and poorly drawn laws. He
said in 1878 in the Federalist Paper,
"It will be of little avail to the people
that the laws are made by men of their
own choice if the laws be so volumuous
that they cannot be read, or so in-coherent
that they cannot be under-stood
if they be repealed or revised be-fore
they are promulgated or undergo
such incessant changes that no man,
who knows the law, today can guess
what it will be tomorrow."
During the last two years, there has
been considerable interest in doing
something about the regulations of
county and district boards of health,
and I have had the pleasure of working
with a number of you in that connec-tion,
working with you on revising
ordinances, or regulations as the
statute terms them, of district and
county boards of health. There have
been regulations drawn in fields that
are new to county health codes which
supplement the regulations of the State
Board of Health; such as, regulations
of private water supplies, one county
now has; regulations of swimming
pools; regulations of trailer parks. Now
some of those things are products of
modern day science; of course private
water supplies we have had for a long
time. But, the trailer park problem
didn't exist a couple of decades ago and
it is illustrative of the new problems
and the new fields of regulations which
you folks in health work have had to
get into. But, it is also illustrative of
subject matter not dealt with in the
statutes covering in a general advance
of power and vmdoubtedly in the scope
of county boards of health as a legal
proposition. But there is a great deal of
that new material which the statutes
are about, which is one of the major
reasons why we need to look into the
conditions of these statutes.
Now, on the State side, the State
Statutes and the regulations of the
State Board of Health, the job of the
revision of the statutes to make them
fit the present day needs and practices
of State and local health agencies, is,
of course, a much bigger project than
January, 1954 The Health Bulletin 15
the job of revising the local regula-tions.
But, it is much more important,
much more urgent than the local ones
are. I am glad to be able to say that
preliminary research has already begun
toward this end, toward the study of
the problems looking toward the re-vision
of the State Health Laws, and
the preparation of a newly codified set
of State Health Laws. It was begun by
the staff of the Institute of Govern-ment
at the request of the State Health
Authority. Now this project was under-taken
by the Institute of Government
and the committees from the State
Board of Health and local health offi-cers
of the State, with the understand-ing
that committees representing the
various technical specialists in the fields
of public health would work closely and
advise the staff members of the Insti-tute
examining with care every pro-vision,
every detail of every provision,
of our existing health statutes with
the public health specialist making the
decision with respect to what should
be kept, what should be thrown away
in the statutes as they now exist. Out
of those conferences, and there will be
many such conferences, with many
people, and a good long time of hard
work, would come a tentative draft
which would be submitted to the health
folks all over the State for their sug-gestions
and study before presentation
to the General Assembly. This is a big
task as all of you know, and it will
require much time and work and plenty
of cooperation to bring it to comple-tion.
But, I do indeed think that it
represents the biggest, single legal
problem w^hich we face today in public
health in this State.
NOTES AND COMMENT
By THE EDITOR
BOVINE BRUCELLOSIS VACCINE
CAUSES INFECTION IN HUMANS
The first definite proof that direct
contact with the vaccine used to im-munize
cattle against brucellosis can
cause human brucellosis (undulant
fever) was reported in an article and
an editorial in the Journal of the
American Medical Association.
With this proof went the warning
that the vaccine contains a viable
pathogen, and that it should be han-dled
only by qualified persons, prefer-ably
veterinarians, and then with the
knowledge that accidental contact with
it may result in active brucellosis.
The case reports of two 25-year-old
veterinarians who became ill after acci-dental
infection with the vaccine, pro-duced
from Brucella abortus, strain 19,
while immimizing calves were described
by Drs. Wesley W. Spink and Hugh
Thompson, Minneapolis. The doctors
are associated with the department of
medicine and the student health serv-ice,
University of Minnesota Hospitals
and Medical Schools.
One veterinarian became infected
when the needle of the syringe con-taining
the vaccine accidentally enter-ed
the palm of his right hand. In the
second victim, the vaccine accidentally
splashed into both eyes. Both men be-came
quite ill, but recovered following
treatment.
"An effective means for immunizing
cattle against brucellosis involves the
infection of viable organisms of Br.
abortus, strain 19," the doctors stated.
"In the campaign to eradicate bovine
brucellosis, strain 19 is being used ex-tensively
in the United States and in
other countries where Bang's disease is
a problem.
"This report on human brucellosis
caused by strain 19 does not imply in
any way that the use of vaccine should
be curtailed. It does emphasize, how-ever,
that strain 19 is not innocuous
and that it should be handled only by
quaUfied persons, preferably veteri-narians,
and then with the knowledge
that the accidental introduction of the
organisms into the hioman subject may
16 The Health Bulletin January, 1954
be followed by illness."
The doctors pointed out that no
evidence has been presented to show
that persons have contracted brucel-losis
from cattle vaccinated with this
strain.
DRINKING AND EVIPORTANT
ACTIVITIES DON'T MIX
If you have something important to
do, don't drink beforehand.
The greatest danger from the use of
alcoholic beverages concerns the rela-tionship
of drinking to subsequent ac-tions,
a medical consultant wrote in
the Journal of the American Medical
Association, stating:
"For example, the after-dinner drinks
may be perfectly harmless if no im-portant
activities are undertaken at
such times, where as the drink taken
before driving a car, running machin-ery,
or performing any task that de-mands
accurate decisions or mental
acuity might be dangerous. The drinker
should observe the following rule: For
every two drinks, he should wait three
hours before undertaking important
activities."
Contrary to popular opinion, the mix-ing
of alcoholic drinks does not in-crease
the intoxicating effects of alco-hol,
since these symptoms depend on
the actual amount of alcohol consumed
and other factors, he stated. However,
this old wives' tale concerning the mix-ing
of beverages may be of value, since
promiscuous sampling is likely to lead
to greater consumption of alcohol, just
as a great variety of foods may lead to
overeating, he said.
Concerning the amount of alcohol
that can be tolerated by an individual,
the consultant pointed out that the
effect depends largely on one factor
—
the amount of alcohol that accumulates
in the blood.
"The amount that accumulates de-pends
on the amount ingested, the size
of the person, the concentration of
alcohol in the beverage, the presence
of food in the stomach, the rate of
oxidation and elimination of the alco-hol,
and, particularly, on the rate of
drinking," according to the consultant.
"The average person can oxidize and
eliminate about six to ten cc. of pure
alcohol per hour, so that he could con-sume
about a pint (500 cc.) of 100 proof
whiskey in 24 hours without ever being
intoxicated if he spaced his drinks pro-perly.
On the other hand, a single
drink consumed rapidly on an empty
stomach may produce measurable
symptoms of intoxication.
"A convenient guide for comparison
of the amount of alcohol in beverages
is that one ounce (30 cc.) of 100 proof
whiskey contains about as much alco-hol
as three ounces (90 cc.) of wine
(17 per cent by volume) or 12 ounces
(360 cc.) of beer (four per cent by
volume)."
URGES STANDARDIZATION,
INCREASED BED CAPACITY
OF NURSING HOMES
The time has come for the standard-ization
and an increased bed capacity
of nursing homes, in the opinion of
Dr. Thomas P. Murdock, Meriden,
Conn.
"The overloading and overburdening
of the general hospitals, the increased
cost of hospitalization, the increase in
life expectancy, the large niunbers of
persons covered by prepaid hospital
and medical plans, and the undoubted
increase in the number of persons
suffering from long-duration illness all
indicate that from this time on the
nursing homes will take their rightful
places in the sim," Dr. Murdock, a
member of the board of trustees of the
A.M.A., wrote in the Journal of the
American Medical Association.
The life expectancy and aged popula-tion
in the United States are con-tinually
increasing. Dr. Murdock point-ed
out. Statistics have shown that old-er
persons are particularly prone to
such long-duration illness as heart and
blood vessel diseases and cancer. Great
numbers of these patients with long-duration
and probably incurable ill-nesses
in general hospitals could be
cared for as well, if not better, in nurs-ing
homes.
MEDICAL LIBRARY
U . OF N. C
.
CHAPEL HILL. N. C.
I TKis Bulletin vdll be sent free to arwi ciiizen of ri\e 5iate upon request I
Published monthly at the office of the Secretary
Entered as second-class matter at Postoffice «t Raleigh,
of the BoardrtflelgWDiVirn
N. C. under H{o^(gits«2RTA CAFloLlNA STATE B^AaP-^ AEALTA] IJ^J
Vol. 69 FEBRUARY, 1954 No. 2
J. W. R NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor
RITES PLANNED SUNDAY FOR DR. LARGE
Rites will be held here on Sunday
for Dr. H. Lee Large, prominent Rocky
Mount physician who was actively
identified with public health, both on
the local and state levels, for many
years. Dr. Large died late yesterday
afternoon in a local hospital following
a long illness. He was 62 years old.
The Rev. Ira A. Kirk, pastor of the
Fu'st Christian Church, will conduct
the funeral services at 3 o'clock Sunday
afternoon from the home, 936 Sycamore
Street. Burial will follow in Pineview
Cemetery. The family has requested
that no flowers be sent. However, those
interested were asked to contribute to
the building fund of the First Chris-tian
Church of which Dr. Large was a
member.
At the time of his death. Dr. Large
was the senior member of the State
Board of Health. He had been Rocky
Moimt's first health officer and was one
of the pioneers in public health work
in North Carolina.
The following statement was includ-ed
in resolution passed by the State
Board of Health in 1951 and forwarded
here today by oflQlcials of the state
agency
:
"Dr. Large has brought to the board
a wealth of experience in public health.
In fact, he is the only board member
who has served as a public health
officer. We do not recall a single reso-lution
introduced by Dr. Large before
•Rocky Mount Evening Telegram, Jan. 30,
1954
the board which has not been carried
without dissent. He has more than
once poured oil on troubled waters at
meetings of this board when trouble
and dissension was brewing or present."
Dr. Roy Norton, state health officer
and one time city health officer in
Rocky Mount, declared in a statement,
"I have never known a more devoted,
conscientious and energetic worker to-ward
every thing for the betterment
of his community and state than Dr.
Lee Large. He gave freely of his time
and energy and served through more
than one period of several months as
city health officer while refusing to ac-cept
remuneration for these services.
His passing is a loss to thousands in
the city and state he loved but his good
work will continue to add health and
happiness to many who never knew
him."
Last year, the City of Rocky Moimt
paid tribute to Dr. Large by naming
for him the new health center, soon to
be constructed here.
Dr. Large was a graduate of the
Medical College of Virginia at Rich-mond
in the class of 1917. He started
his work with the City of Rocky Mount
in the fall of 1917, serving as city
health officer imtil 1931 when he be-came
connected with Park View hospi-tal
as urologist. He was also urologist
for the Atlantic Coast Line Hospital
here. Since 1931 he had served as con-sxilting
or relieving health officer.
Also in 1931 the late Governor O.
The Health Bulletin February, 1954
Max Gardner named Dr. Large to the
State Board of Health. He remained a
member of that board vmtil his death.
A past president of the local medical
society. Dr. Large also took an active
part in coimty health aflfairs in Nash
and Edgecombe and was an active
member of the State Medical Society.
Dr. Robert Walker, present Rocky
Mount health ofBcer, paid the follow-ing
tribute:
"In the loss of Dr. Large, Rocky
Mount and the State of North Carolina
suffered a severe loss. He was one of
the pioneers in public health work and
his whole heart was wrapped up in
serving the health needs of the city
and the State. No single man in the
State has done as much for public
health work as Dr. Large."
Dr. Large was a native of Virginia,
the son of the late D. W. W. Large and
Mrs. Emma Botts Large. His mother,
who survives, lives in Appalachia, Va.
He was born October 6, 1891. He mar-ried
the former Nellie Pearle Brockwell
of Richmond, Va., who survives.
In addition to his mother and his
wife. Dr. Large is survived by three
sons, Dr. H. Lee Large, Jr., of Char-lotte,
Dr. Nelson D. Large of Alex-andria,
Va., and Harry S. Large of
Huntington, W. Va., two daughters,
Mrs. Harry Hollingsworth of Durham
and Mrs. Fred Best of Columbus, Ga.;
and one brother, Stallard Large of
Appalachia, Va.
Pallbearers for the funeral on Sun-day
will be Dr. Robert Walker, Dr. C.
T. Smith, J. W. Sexton, Earl Ewer, D.
S. Johnson and Neal Adkins. Honorary
pallbearers will be members of the
Boice-Willis Clinic and the Edgecombe-
Nash Medical Society.
AN UNCOMMON MAN
The passing from our midst of Dr.
H. Lee Large leaves a great vacancy in
the life of this community, this state
and in many hearts. We shall miss
him.
We shall not see his likes again soon.
In an age which placed a premium
on mediocre conformance to colorless
mass standards, he dared to be a non-conformist.
The many-faceted range of
his personality sparkled and illumined
a great spirit and gave eloquent testi-mony
of the grandeur and sacred worth
of the hxmian individual. The force of
his personality, the strength of his
character, the nobility of his piu-pose
set him apart from his fellowman. He
was an imcommon man.
The world—particularly North Caro-lina—
is a little healthier, a little
•Rocky Mount, N. C. Sunday Telegram,
Sun., Jan. 31, 1954
brighter, a little happier because Lee
Large passed this way. His service
reached out far beyond those who look-ed
to him as their physician. In infinite
ways his work touched the lives of
countless people everywhere in North
Carolina who have benefitted from the
public health program.
Truly no other North Carolinian has
done so much for public health in this
state as Dr. Large. He was the senior
member of the State Board of Health
and had pioneered in the state's public
health program. In 1917 he became the
city's first public heatlh officer and
served until 1931 when he became a
member of the State Board of Health.
We rejoice that he lived to see his
labors bear fruit and to see his name
honored among men in so fitting a
memorial as the new health center in
Rocky Mount which will bear his name.
Hail and farewell!
February, 1954 The Health Bulletin
PUBLIC HEALTH ASPECTS OF COOKING
GARBAGE FOR HOG FEEDING*
By MARTIN P. HINES, D.V.M., M.P.H.**
North Carolina State Board of Health
Those of us who are servants of the
people in the profession of pubhc
health have or should have an interest
in everything that directly, indirectly,
or remotely affects the public health.
The subject of feeding raw garbage to
swine certainly falls in this category.
The present widespread outbreak of
vesicular exanthema (hereafter called
"V.E.") which threatens the swine in-dustry
has greatly promoted the cook-ing
of garbage fed to swine. Public
health ofiBcials are taking advantage of
this widespread interest in "V.E." to
stimulate and promote the control of
diseases of swine transmissible to man.
Of these, trichinosis is of most import-ance.
The feeding of tmcooked garbage to
hogs under the usual insanitary con-ditions
should not be tolerated by a
conscientious local governing body. I
do not take the position that garbage
should not be fed to swine. The United
States Department of Agriculture in
1941 estimated that 200 million poimds
of pork could be produced annually if
all garbage produced in the urban
areas of the United States were utilized
for hog feeding.
Producing human food from garbage
is obnoxious to say the least, but when
we consider that our population in 1975
will reach 200 million and that most
other countries have an even higher
birth rate, it is very probable that the
day will come when our children's
children may be happy to have food
produced from garbage.
The practice of feeding imcooked
garbage to hogs under insanitary con-ditions
affects the public health in
four different ways, namely, those dis-
• Presented at the 1953 Inter-state Sanita-tion
Seminar, Athens, W. Va. Augxist 24-
28, 1953.
•Chief, Veterinary Public Health Section.
eases directly transmissable from swine
to man, those diseases that affect sole-ly
swine and other animals, those ani-mal
diseases which are extremely dan-gerous
from a civil defense standpoint,
and miscellaneous public health prob-lems.
I shall elaborate briefly on each
of these.
Diseases Transmissible to Man
1. Trichinosis. The life cycle of this
parasitic disease of man is well known.
The incidence of trichinosis in both
man and animals in the United States
is the highest of any coxintry in the
world. England and Canada both have
long practiced cooking of raw garbage
fed to swine and consequently have
about one-twelfth of the human infec-tion
foimd in the United States. One
person out of six in the United States,
or about 25,000,000 of those alive today,
probably harbor trichinae. To reach
this total there would have to be 350,-
000 new infections each year. Using 50
larvae per gram as the threshold for
producing symptoms, 4.5 per cent of all
persons infected or about 16,000 should
exhibit clinical symptoms each year.
This is a great deal higher than the
average of 300 cases reported each year
in this coxmtry. Difficulty in making a
clinical diagnosis, inadequate reporting,
and mildness of symptoms are respon-sible
for the small number of reported
cases. It is estimated that of 60,000,000
hogs slaughtered each year in the
United States, 1.5 per cent are infected
with trichinae. The majority of the
950,000 infected swine can be blamed
on raw garbage feeding. A recent study
by Schwartz indicates that the preval-ence
of trichinosis in farm-raised swine
is only 0.63 per cent compared to 11.21
per cent in garbage-fed hogs. It is said
that during a lifetime each pork eat-ing
American wUl eat infected pork 200
times. Whether or not this pork has
6 The Health Bulletin February, 1954
been properly cooked will determine its
infectivity.
Before leaving the subject of trich-inosis
a few comments should be made
about protection against this parasite
through meat inspection. The federal
meat inspection service (U. S. D. A.)
makes no attempt to inspect swine car-casses
for trichinae. To do so would be
futile and leave the public with a false
sense of security. They do, however,
require all pork products customarily
eaten without cooking to be processed
(heating or freezing), in order to kill
the trichinae. A recent survey found
that products treated in this manner
contained only dead trichinae. Bacon,
fresh pork sausage and similar break-fast
sausage, ham, pork shoulder and
fresh pork cuts that have been cured
but not smoked or otherwise processed
should be thoroughly cooked before
they are eaten.
It is easy to see how trichinae can
get into the food of an innocent diner
if pork sausage is served. You have all
seen a cook place a patty of sausage
on the work board by the grill, pat it
out, and then place it on the grill to
cook. Later the bread is placed on the
board where the raw sausage was.
When sausage is done, it goes on the
bread and the sandwich is picked up
with raw shreds of meat that adhere
from the board. And how about the
"hamburger joint" which partially sub-stitutes
pork for beef in the hamburger
when the price of pork is cheaper than
beef. You have eaten these hamburgers
that are so rare they "moo" at you!
Yes, even if we do cook our garbage
fed to hogs, we must continue our
educational efforts toward the adequate
cooking of all pork products.
2. Salmonellosis. Over 200 species of
salmonella have been described and
many are found in swine. Causing a
food infection in man when contami-nated
food is ingested, salmonellosis
outbreaks are frequent among garbage
fed hogs. Poor sanitation contributes
to the spread of this disease, but it can
be eliminated if hogs are placed in
clean pens and given a ration contain-ing
no raw garbage.
3. Tuberculosis. Swine are susceptible
to all three types of tubercle bacilli.
The human type is almost always
found in swine fed on raw garbage;
therefore, it is quite dangerous to feed
swine uncooked garbage from hospitals
and sanatoria. One study reported 30
per cent of hogs fed on garbage from
a tuberculosis sanatorium were infected
with the hiunan type of the disease.
4. Swine Erysipelas causes a septi-cemia
in swine when acute, and joint
involvement when chronic. In man a
local lesion at the site of injury is
produced upon contact with infected
swine. Poultry are also affected with
this disease. It is believed that meat
scraps in uncooked garbage causes the
spread of this disease among swine.
5. Brucellosis, (undulant fever) In
general, this disease in swine has a
greater clinical resemblance to brucel-losis
in man than the disease in cattle.
Hutchings in a study revealed that B.
suis could be isolated from organs and
tissues of infected animals held at 40°
F. for as long as 20 days after slaught-er.
One could conclude from this study
that raw garbage could easily spread
this disease through swine to man.
Diseases Affecting' Only Animals. Any
diseases that affect the health of our
livestock affect the public health, both
from the standpoint of a loss of food
supply and the damaging effects to
our agricultural economy. Hog cholera,
"V.E.," and foot-and-mouth disease are
the most important diseases spread
through raw garbage feeding.
1. Hog Cholera. Hog cholera is the
most important hog disease in the
United States. The mortality is high
and vaccination must be carried out
each year, once a farm is infected. Un-cooked
pork scraps in garbage carry
the virus. Garbage feeders in Canada
cook their garbage and there is no
cholera in Canada! The United States
now realizes that this disease must be
eradicated. Heat treatment of garbage
will contribute much to the success of
this campaign, for Dr. B. T. Sims, Chief
of United States Bureau of Animal
Industry, says, "We can never elimi-
February, 1954 The Health Bulletin
nate hog cholera as long as we feed
raw garbage."
2. Vesicular Exanthema. A disease of
swine which first appeared in Cali-fornia
in 1932 and remained endemic
in this state until 1952 when it spread
eastward. In 1952 infected hogs were
first seen in Grand Island, Nebraska,
and originated from a garbage feeding
lot in Cheyenne, Wyoming. Shortly
thereafter the disease spread to 32
states. Most outbreaks have occurred
in raw garbage feeding establishments
while some were in grain-fed hogs that
contacted diseased hogs en route to
market. Immediately after the outbreak
was recognized, the price of pork drop-ped
substantially and many people
perhaps stopped eating pork because
of the adverse publicity, pointing out
the effects on the economy. Tlie great-est
thi-eat of "V.E." is that it resembles
foot-and-mouth disease and every case
must be differentiated by expensive
animal tests.
3. Foot-and-Mouth Disease. The last
two outbreaks of foot-and-mouth dis-ease
in this coimtry started in hogs fed
raw garbage. Before stopping these
outbreaks, 975 farmers had their herds
destroyed and it cost the United States
$100,000,000 to stamp out the disease.
In recent years we have spent over
$200,000,000 to keep the disease from
entering this country from Mexico. No
wonder we are terrified at the existing
possibility of "V.E." masking foot-and-mouth
disease all over the coimtry.
Transmission of foot-and-mouth dis-ease
virus by infected meat scraps has
been known for a long time.
Civil Defense. Among the animal dis-eases
that have been listed as those
most likely to be used against us in
biological warfare aimed at "knocking
out" our food supply are foot-and-mouth
disease, rinderpest, exotic strains
of hog cholera, Asiatic Newcastle dis-ease
and fowl pest. Our civil defense
authorities already are greatly con-cerned
by the confusion that the re-cent
outbreak of "V.E." is causing be-cause
of the marked clinical similarity
to foot-and-mouth disease and of the
extensive diagnostic procedures neces-sary
to differentiate the two on the
occasion of each new outbreak. Actual-ly
this is of more importance to cattle
men because of the jeopardy in which
it places our cattle industry by pos-sibly
having foot-and-mouth disease
masked as a hog disease. There is little
doubt that our enemy will use all pos-sible
means to create confusion and
disaster. What better means could be
used than by seeding our country with
exotic livestock diseases?
Miscellaneous Public Health Pro-blems.
There are several other prob-lems
created by garbage feeding under
insanitary conditions such as:
1. Solid wastes left from garbage
feeding if not disposed of fre-quently
blocks drainage and causes
prolific breeding of mosquitoes.
2. Presence of flies, vermin and rats.
The latter spread trichinosis among
hogs and also transmit other seri-ous
diseases to man (typhus, lepto-spirosis)
.
3. Obnoxious aerial nuisances are
present which local health depart-ments
are often requested to have
abated.
4. Business and industry are reluct-ant
to move into such an area be-cause
of the strong odors and un-sightly
conditions, making pro-perty
values and tax returns low.
In conclusion, I am happy to report
that North Carolina now has a law
requiring the cooking of all garbage
fed to swine. This law also takes into
consideration the sanitation of such
feeding establishments, including rat
and fly control. It is administered by
the State Veterinarian imder the De-partment
of Agriculture. There is com-plete
cooperation between local and
state health officials, with agriculture
ofBcials responsible for the enforcement
of this law. At present, seven laymen
and one veterinarian are employed to
inspect garbage feeding establishments.
Although we have never been a heavy
garbage feeding state, we do have sev-eral
military installations that are pro-viding
garbage feeding problems. It is
really ridiculous that a nation as civil-ized
as we claim to be has permitted
8 The Health Bulletin February, 1954
for so long a time a situation where
one-half of one per cent of the garbage
fed livestock imperils the entire agri-cultural
economy of the covmtry, not
to mention the important public health
aspects of garbage feeding. I believe at
last we have awakened to the fact that
the prevention, control and eradication
of trichinosis, vesicula exanthema and
foot-and-mouth disease depend upon
the elimination of raw garbage feeding
of livestock in the United States. We
are at last heading in the right direc-tion.
GOOD TEETH—FOR YOU, YOUR CHILD,
YOUR COMMUNITY
The Council on Dental Health of the
North Carolina Dental Society is spon-soring
this series of articles on Dental
Health. The writer, Dr. Ei-nest A.
Branch, is the Director of the Division
of Oral Hygiene of the North Carolina
State Board of Health, Raleigh, N. C.
Topical Application Of Sodium
Fluoride To Children's Teeth
In previous articles the case for
fluoridation of commimity water sup-plies,
as an effective and safe large-scale
means of reducing dental decay
has been presented. Fluoridation, you
will recall, is the adjustment of the
fluoride content of the public water
supply to one part fluoride to one mil-lion
parts water. The results of much
research during the past flfty years
substantiate the finding that persons
who used fluoridated water since birth
have two-thirds less tooth decay than
those who have used fluorine-free
water. Fluoridation has been endorsed
by the leading dental, medical, and
public health groups.
To-day, we are thinking about the
children who live in areas where there
are no municipal water supplies—chil-dren
who live on farms and in small
villages. In North Carolina, with a pre-dominantly
rural population, there are
literally thousands of children who
carmot drink fluoridated water.
Fortunately, these children, too, can
benefit from fluorides. Researchers
have discovered and perfected a meth-od
for applying sodium fluoride direct-ly
to the surfaces of teeth. This is
called the topical application of sodium
fluoride. Surveys have shown that this
treatment has reduced dental decay by
40 per cent in large groups of children.
Please note the modifying phrase, "in
large groups of children." Parents
should know that results vary among
individuals and that evei-y child may
not be benefitted. However, we believe,
along with the Council on Dental
Health of the American Dental Asso-ciation,
that the favorable results justi-fy
our recommending to parents the
topical application of sodium fluoride
to their children's teeth by their den-tists.
For this partial protection against
tooth decay a two per cent solution of
sodium fluoride is used. The dentist
cleans the teeth thoroughly before the
first application. He then dries the
teeth with compressed air. To the dried
enamel surfaces he applies the two per
cent solution of sodium fluoride, allow-ing
it to dry on the teeth. A series of
four separate applications is given at
intervals of from three days to a week.
Four applications are essential for
maximum effectiveness.
The first such series of treatments
should be given when a child is three
years old to protect his baby teeth. The
treatments should be repeated at three
to four year intervals, or at about the
ages of 7, 10, and 13 years. In this way
all teeth will be treated soon after
they come in the child's mouth. If
applications have not been given at the
suggested ages, they may be given later
for they are effective at any age under
16.
As stated above, the topical applica-tion
of sodiimi fluoride is recommend-ed
for children in rural areas and for
February, 1954 The Health Bulletin 9
children in towns which have not yet
fluoridated their water supplies. Water
fluoridation, where possible, is more
economical and far reaching as a pre-ventive
measure.
Neither the fluoridation of water
supplies nor the topical application of
sodium fluoride will prevent all tooth
decay. Other measures recommended
for the promotion of good dental
health are:
1. Regular visits to the dentist for
the early detection and correction
of dental defects.
2. Brushing the teeth immediately
after eating.
3. Eating a balanced diet with sweets
reduced to a minimum.
A CONQUERING HERO
By WILLIAM H. RICHARDSON
State Board of Health
Raleigh, North Carolina
In view of the fact that North Caro-lina
recently dedicated a hospital for
the treatment of tuberculosis at Chapel
Hill, which cost $1,186,000 we are going
to consider in this article the evolution
of sanatorium treatment for tubercu-losis,
together with some facts about
the pioneer in that field in the United
States. The new institution was named
in honor of the late Lee Gravely of
Rocky Mount, whose efforts in behalf
of tuberculosis sufferers marked him
as a great North Carolinian.
This country of ours have produced
many heroes who did not wear imi-forms.
One of these was Edward Liv-ingston
Trudeau. He was born in New
York City, October 5, 1848. His father
and his maternal grandfather both
were physicians. When he reached ma-turity
he, himself, decided to follow in
his father's and grandfather's footsteps
and enter the medical profession. This,
however, was after the death of his
brother, who was a victim of tubercu-losis.
Prior to his brother's death, he
had decided to enter the navy. He was
about to enroll at Annapolis when his
brother became ill, and he decided to
remain with him, instead of pursuing
his original intention.
Trudeau entered medical school in
1868. Upon completing his studies, he
married and began practicing in New
York. Soon he began to feel tired all
the time, and was advised to have his
lungs examined. The physician who
examined him found that, his left lung
was actively tuberculous. At that time
tuberculosis, which was called con-sumption,
was considered absolutely
fatal. This diagnosis altered the pat-tern
of Trudeau's whole life.
Braced For A Fight
After being told he had tuberculosis,
he said that he was at first stunned,
and the world seemed to black out.
Thinking, he had only a short time to
live, he decided to go to the Adiron-dacks,
in order to be out in the open
as much as possible. He reached his
destination in May, 1873, and took up
residence at a hunting lodge. Life in
the mountains improved Trudeau's
health. He began to eat and sleep
normally and his fever left him. He
returned to New York, in September,
having gained 15 pounds. Before long,
however, he began slipping again, so
he decided to spend the next winter
in the mountains.
The lodge keeper finally was per-suaded
to let him remain for the
winter months. The feeling at that
time was that a person with tubercu-losis
should go to a warm climate. On
one occasion, during his winter stay
in the Adirondacks, it was necessary
for Trudeau to take shelter in a snow
cave, on his return to the lodge. He
went through that first winter almost
free of fever. When the guests began
to return, the following spring, they
10 The Health Bulletin February, 1954
were astonished to learn that Trudeau
and his wife had remained up there
throughout the winter.
Upon the decision of the lodge keep-er
to move to another location and
open a hotel for the winter, Trudeau
began looking for a place where he
could have a house of his own. He
finally decided to take up residence
on Saranac Lake. He rented a house
from a guide. The keeper at the lodge
where he formerly stayed lent him
some furniture. He spend much of his
time hunting. Sometime after arriving
at Saranac Lake, he was struck by a
brilliant idea—that of building a sana-torium
similar to Brehmer's in Silesia,
in Europe. Brehmer first used the
sanatorium treatment in pulmonary
tuberculosis cases.
In the summer of 1882, Trudeau met
Dr. Alfred Loomis, who had treated
him, from time to time, and told him
of his plan to build a cottage at
Saranac Lake, where patients of mod-erate
means could get rest and care,
and where he could start his sanator-ium
methods of treating tuberculosis.
Dr. Loomis agreed to send Trudeau
patients and to examine them free of
charge.
When Trudeau went do'wn to New
York that summer, he called some of
the people he knew and asked for sub-scriptions
for the sanatorium. Many
could not understand what he was try-ing
to do. They argued that tubercu-losis
could not be cured. However, he
did collect more than $3,000. He kept
adding to the sum and, finally, was
sure that, in due time, he could start
putting up a small building. The first
cottage was completed in February,
1885. It had just one room, 14 by 18
feet, and a porch so small that only
one patient could sit there at a time.
The fii'st occupants were two factory
girls, who had been sent up by Dr.
Loomis.
Inspired By Koch
While Trudeau was at work plan-ning
his sanatorium, Koch, who was a
German scientist, annoimced that he
had discovered the tuberculosis bacil-lus.
This occurred in 1882. Then the
germ theory v/as comparatively new.
Trudeau had read of the experiment
of Pasteur, the French scientist, who
believed that all infectious diseases
came from living organisms. He learn-ed
much of the work of Lister, who
had proved that antiseptics could keep
wounds from becoming infected. When
he learned of the discovery of Koch,
regarding tuberculosis bacillus immedi-ately
he became very much interested.
He felt that if he could learn to grow
the bacillus outside of the body and
then give tuberculosis to animals, he
might be able to discover something
that would kill the bacillus in human
beings.
He went to New York and begged
some of the old professors to teach
him how to find the bacillus. While
they were indifferent to the discovery
claimed to have been made by Koch,
he saw in it a whole new world, in
the field of fighting tuberculosis.
They gave him a place, in a dingy
old laboratory; and, after much work,
he was able to find tuberculosis bacil-lus.
The next step was how to conduct
experiments that would show how to
be able to kiU it in the human body,
if possible.
When he returned to Lake Saranac,
he fitted up a room, 8 by 12 feet, in
a frame cottage, and began the tedious i
task of making experiments. He faced
many discouraging situations, but kept
constantly at work for humanity. All
the while, friends put up many build-ings
for his sanatorium; they helped
him manage the funds collected. The
physicians of the younger generation
kept him supplied with knowledge they
gained.
Experiments With Rabbits
He experimented with rabbits, to
learn how changes of climates, rest,
fresh air, and food affected the germs
of tuberculosis, after they had entered
the body. These experiments proved
to Trudeau that bad surroundings, in
themselves, did not cause tuberculosis,
but that, once the disease had develop-ed,
it was greatly influenced by a
February, 1954 The Health Bulletin 11
favorable or unfavorable environment.
The essence of the sanatorium treat-ment
that Trudeau carried out was a
favorable environment, so far as clim-ate,
fresh air, food, and regulation of
the patient's habits were concerned.
This same principle still is used in
sanatorium treatment of tuberculosis
in North Carolina and elsewhere, and
it has prolonged countless lives.
As the years went by, the sanatorium
at Lake Saranac grew steadily, in
building, equipment, and in staff mem-bers.
But this great human benefactor
was not without his personal sorrows,
as well as his joys. Between 1893 and
1904, during which time the sanatorium
was steadily growing, he lost his
daughter, who was a beautiful and
promising young woman, and his son,
Ned, who already had begun practicing
medicine in New York City. He made
the statement that, during these dark
and sorrowful days, it was the sym-pathy
of his friends that kept him
going. Despite his great losses, Tru-deau
maintained his courage and con-tinued
to carry on his work, with an
indomitable will. He reached the end
of his earthly journey in 1915, but the
work which he did will ever live as a
: tribute to one of the great soldiers in
I
the battle against tuberculosis.
, While, to the man on the street,
the name Trudeau may mean little or
nothing, to those engaged in the work
' of endeavoring to find new ways and
means of combating tuberculosis, it
will remain a synonym for hard work
and coiurage. It must be remembered
that he, himself, fell victim to tuber-culosis
early in life, and that it was
this fact that inspired his great fight,
after he had conquered the disease in
his own life. In saving himself, he
endeavored to save others.
||
Some Tangible Results
If Trudeau were alive today—if he
should come to North Carolina—he
would see that the practices he began
in the sanatorium treatment of tuber-culosis
have become general; he would
find that North Carolina not only is
using his methods, but that it has in-vested
many thousands of dollars to
cut down the waitii:ig lists at oiu:
various sanatoria. If he should study
our statistics on tuberculosis, he would
find that, while tuberculosis killed 3,577
North Carolinians in 1916, it was re-sponsible
for only 543 deaths last year.
The death rate fell from 142.3 to just
13.0 for 100,000 population. That is a
large number, to be sure, but think
what the total would have been, with
our greatly increased population, had
the death rate remained what it was
in 1916.
If he should visit North Carolina
today, Trudeau would find Public
Health engaged in a mass x-ray sur-vey
in the State, to determine those
who are in need of the sanatorium
treatment, which he initiated, back in
those experimental days, when con-sumption
was considered an incm-able
disease. Furthermore, this great soldier
in the battle against "the great white
plague" would find that, already, chest
pictures have been made of nearly two
million persons fifteen years of age,
and older. The goal is an x-ray of the
entire population over fourteen.
The gains we have made have been
coincidental with the rise in the Amer-ican
standards of living, bearing out
Trudeau's findings that persons with
healthful surroundings who have fallen
victim to tuberculosis have a better
chance to recover. The rise in the
American standard of living has been
due, in no small part, to improvements
in the labor laws, which have brought
workers not only increased pay, but
shorter hours, enabling them to enjoy
more time in recreation and sunshine.
More money means more and better
food, more opportunities for the educa-tion
of the young, and better housing.
12 The Health Bulletin February, 1954
NOTES AND COMMENT
By THE EDITOR
The immunization status of the chil-dren
in any health department area is
at best difficult to estimate without
extensive survey techniques. The Dela-ware
State Board of Health has com-pleted
a state-wide survey which is
reported in a recent issue of the Dela-ware
State Medical Journal. The in-formation
gained during this survey
should be of interest to all physicians
and public health workers.
The returns were obtained from the
parents of some 2000 children born
between January 1, 1952 and April 30,
1952. At the time of the initiation of
the survey these children were from
8 months to one year of age. By the
time the survey was completed the
children were from 14 to 18 months of
age.
The significant results include:
72% of children had completed im-munization
again diptheria, whooping
cough and tetnaus given as triple
toxoid.
25% of children had been vaccinated
against smallpox.
3% had been immunized against
either diphtheria, whooping cough, or
tetnaus with preparations other than
triple toxoid.
Four infants were immimized by
private physicians for every infant im-munized
at a well child conference.
The well-child conferences immuniz-ed
chiefly children in the non-white
group.
Health officials in Delaware felt the
survey again emphasized the need for
continuing stress on the importance
of immunizations within the first year
of life.
4> * * *
Intestinal parasites are now consider-ed
by many as "nusiasance" diseases
and the lowly worm, once the cause of
sickness and disability for thousands, is
no longer thought of as a public health
problem.
Interesting in-sight into the preval-ence
of intestinal parasitism is given
by a recent report from the North
Carolina State Laboratory of Hygiene
on the incidence of stool specimens
found to contain parasites during the
period January through June 1953.
During the six month period, a total
of 10,121 stools were examined and
1,876 or 18.5% were found to contain
some type of parasite. These specimens
were received from 60 of North Caro-lina's
100 counties. Eighty per cent, or
about 1,500 of the positive specimens
contained hookworm. A total of 277, or
14.8% contained ascaris; 47 specimens
were positive for oxyaris, and 23 con-tained
E. histolytica. Some 41 speci-mens
showed evidence of multiple par-asitic
infestation with hookworm and
either ascaris, oxyaris or trichuris.
Fifty-six per cent of the positives
come from five North Carolina coun-ties.
New Hanover, Duplin, Hoke,
Cherokee, and Columbus.
Although these specimens were ob-tained
from individuals who were sus-pected
of having parasitic disease, and
do not represent a random sample of
the total population, they do indicate
a health problem of considerable mag-nitude
may be lurking imder our feet.
* * * *
VOMITING IN CHILDREN MAY BE
SIGN OF EMOTIONAL DISORDER
Vomiting may be the first and only
indication of an emotional disorder
in an infant or child, in the opinion
of Dr. Paul C. Laybourne Jr., Kansas
City, Kan.
"The infant has only a few ways in
which to express undue emotional ten-sion,"
Dr. Laybourne wrote in the
American Journal of Diseases of Chil-dren,
published by the i\merican Med-ical
Association. "He can refuse food,
cry excessively and vomit."
Much psychological vomiting in in-fants
and children is the result of a
disturbing atmosphere at home, Dr.
Laybourne pointed out, stating:
February, 1954 The Health Bulletin 13
"It is obvious in such cases that
direct treatment of the baby or child
is unnecessary. Psychological vomiting
in infants is easily diagnosed by the
simple expedient of hospitalizing them.
Almost universally the vomiting stops
with the removal of the baby from the
disturbing environment of the home.
This observation helps in making a
differential diagnosis between organic
and psychologic disease."
If no definite organic basis for the
vomiting of a baby can be established,
the emotional attitude of his mother
should be thoroughly investigated ac-cording
to Dr. Laybourne, as a severe
emotional disturbance in the mother
can be transferred to the baby.
"Just exactly how the psychic ten-sion
is transmitted to the child is
poorly tmderstood," he said. "If the
mother can communicate positive and
happy feelings to the baby by the tone
of her voice and expression on her
face, it would seem reasonable to as-sume
that disturbances in the mother,
I which produce tenseness and anxiety
i in her voice, as well as in her behavior,
I
can also be communicated to the
i child."
Treatment of babies whose emotional
I disorder is a reflection of that of their
parents' requires that the basic emo-tional
difficulty of the parents be re-solved,
Dr. Laybourne stated, adding:
"Any psychotherapy, therefore, is di-rectly
toward the parents and not the
child. If a successful resolution of the
parents' problem is impossible, the
child should be placed in a warm
friendly environment, so that it need
no longer react to the emotional
stresses of those who care for him.
Children up to the age of about five
years who have emotional vomiting
will respond satisfactorily to simple
environmental manipulation or psychi-atric
treatment of the parent."
As the child gets into the school
age or older, vomiting becomes more
difficult to treat, and combined therapy
of parent and child often is necessary,
he pointed out.
"Here the symptoms of vomiting may
appear less directly related to obvious
emotional disturbances in the parent,"
he added. "The vomiting often makes
its appearance following a traumatic
experience to the child, such as an
operation or infectious illness. In these
cases it would appear at first glance
that the operation or illness was the
'cause' of the vomiting. The operation
or infectious illness is only the trigger
mechanism setting off the reaction
which has been building up for many
months or years previously. The basic
difficulty is to be foimd again in the
parent-chUd relationship, and the ulti-mate
cure is brought about by correct-ing
the basic difficulties in the parent-child
relationship."
Dr. Laybourne stated that vomiting
in adolescents and adults also may be
a common symptom of an emotional
disturbance.
Dr. Laybom-ne is associated with the
departments of pediatrics and psych-iatry.
University of Kansas School of
Medicine.
* * * •
CARE AND PLANNING CAN
SALVAGE RETIREMENT
PRODUCTIVITY WASTE
With greater care and planning,
much valuable productivity that now
is being wasted by compulsory retire-ment
can be salvaged, it was stated
editorially in the Journal of the Amer-ican
Medical Association. Older work-ers
who are capable of and desire em-ployment
should be permitted to work,
it added.
As firms take great pains to choose
whom they will hire, there is no reason
why they should not concern them-selves
equally with the problems of
whom they will retire, the editorial
said. Retirement policies, in addition
to setting the conditions of retirement,
should state how older workers may be
profitably kept on the job and how
their status is to be determined.
The best way to determine who
should be retired, according to the
editorial, is for a firm to create a panel
to judge each case on its merits and
determine whether the worker should
continue in his present status, go on a
modified schedule, transfer to a less
14 The Health Bulletin February, 1954
demanding job, or be retired. The
panel, which should include one or
more high level executives and an in-dustrial
physician, should seek advice,
when necessary, from the employee's
immediate supervisor, the company's
personnel director, or the local union.
Restudying of methods of work and a
restudying of training methods also
wall aid in the solution of the problem,
it was added.
"In our aging population the gap
between retirement and death is
widening," the editorial pointed out.
"In 1900 it averaged about two and a
quarter years. This had doubled by 1950
and is still increasing. The reason for
this is a combination of two factors:
the saving of more lives between birth
and age 35, and the policy in many
firms of compulsory retirement at an
arbitrary age, usually 65.
"There is a growing recognition that
a fixed retirement age is ixnprofitable
for the employer, frustrating for the
emploj'ed, and eventually disastrous to
the national economy. Although some
workers become inefi&cient at 65 or
younger, a fixed retirement age works
a hardship on the productive majority
along with unproductive minority."
Although it is true that aging work-ers
suffer a gradual diminution in
strength and in the speed of their
muscular movements, these handicaps
are more than compensated for by an
increase in skill or accuracy and in
reliability and conscientiousness, ac-cording
to the editorial, which added:
"Many workers reach the age of 65
without showing any signs of slowing
up, and they should be allowed to do
some work. If the signs of aging are
beginning to become apparent, much
can be done to salvage the productivity
of the worker. A few who are out-standing
in production departments,
for example, can be taken off produc-tion
and made foremen or supervisors.
Others can be placed where the im-portance
of their increased acciuracy
outweighs the demand for speed.
"Anything that spares these workers
a feeling of frustration adds produc-tive
years to their lives. In some cases.
a worker can be kept on at reduced
hours or in work that is similar to his
usual tasks but less complex. Executives
and professional persons should dele-gate
part of their usual tasks to an
assistant.
"When a person reaches that stage
of life when a modification of his
activities becomes imperative, it is
sometimes wise or even necessary to
change over to an entirely different
type of work. If a person knows or
suspects that change to another type
of work is apt to become mandatory
at 60 or 65, he is wise to embark on
his second career a few years earlier,
because he is then In a better condi-tion
to learn his new duties and he
has a better chance of finding an
acceptable opening."
* * * *
DON'T GET YOUR VITAMINS
OUT OF A COSMETIC JAR
Alchemy makes alluring ads, but it
has no place on milady's dressing
table.
Vitamins have their place, but their
use in cosmetics may constitute a
health hazard, according to Mrs.
Veronica L. Conley, assistant secretary
of the American Medical Association's
Committee on Cosmetics. Writing in
Today's Health magazine, published by
the A.M.A., she stated:
"Prom time to time we hear claims
of something new and different in a
cosmetic. We are told that some prod-uct
is a panacea for wrinkles, crepiness
and other signs of aging. On the basis
of experience, most people view such
claims with a sophisticated eye. They
want more than an advertising claim
to be convinced, since even a quick
glance at the most faithful cosmetics
user is proof that skin aging proceeds
undisturbed.
"This is how we view the recently
revived and widely publicized vitamin-containing
cosmetics. A decade ago the
Federal Trade Commission ordered cer-tain
manufacturers to 'cease and desist'
from claiming that the addition of
vitamins A and D to cosmetics had any
beneficial effect on the skin. Therefore,
the reappearance of vitamin cosmetics
February, 1954 The Health Bulletin 15
about two years ago was the occasion
for some surprise."
During the last few years, Mrs. Con-ley
stated, much has been learned
about vitamins A and D—that they
are not always the good substances
that they were thought to be. Experi-ence
has shown that continued exces-sive
intake can cause serious reactions,
she added. Another important fact dis-covered
in recent years is that vitamin
A applied to the skin of animals causes
local thickening.
"Just what significance this has in
people must still be demonstrated, but
it does indicate that sufficient vitamin
A may cause skin changes," Mrs. Con-ley
pointed out. "Whether they are
good or not remains to be seen.
"The question then follows: 'What
does all of this mean in relation to the
daily use of vitamin A or vitamin A-D
creams over a long period?' The answer
is: 'We don't know.' In spite of this,
vitamin-containing cosmetics are being
promoted for use by the general public.
It is fair to ask whether cosmetics
are a rational place to use vitamins.
Serious vitamin deficiency is rare in
this country. So it cannot be assumed
that such deficiency is a common cause
of the universal skin-aging signs—dry-ness,
lines and wrinkles. There's no
good evidence that, in the rare case
where a deficiency does exist, vitamins
are more effective applied to the skin
than taken orally.
"Large oral doses of both vitamins A
and D are used successfully by physi-cians
for some pathologic skin condi-tions.
This situation is quite different
from the um-estricted application of
vitamins on apparently healthy skin
for beautification."
* * * *
ADDITION OF NUTRIENTS TO
FOOD BENEFICAL TO
NATION'S HEALTH
The addition of specific nutrients to
certain staple foods has been beneficial
to the nation's health and has en-couraged
sound nutritional practices,
the American Medical Association's
Council on Foods and Nutrition re-ported.
However, it stressed the desirability
of the individual meeting his nutri-tional
needs by the use of natural foods
as far as practicable. People should
learn, it was added, the proper choice
and preparation of foods, and better
ways to produce, process, store and
distribute foods.
The coimcil endorsed the enrichment
of flour, bread, degerminated corn
meal and corn grits; the nutritive im-provement
of whole grain corn meal
and of white rice; the retention or
restoration of thiamine, niacin and
iron in processed food cereals, and the
addition of vitamin D to milk, of
vitamin A to table fats and of iodine
to table salt.
"The principle of the addition of
specific nutrients to certain staple foods
is endorsed for the purpose of main-taining
good nutrition as well as for
correcting deficiencies in the diets of
the general population or of significant
segments of the population," it was
stated by Dr. James R. Wilson, Chicago,
secretary of the council.
"In order to avoid imdue artificiality
of food supply, foods chosen as vehicles
for the distribution of additional nu-trients
should be, whenever practicable,
those foods which have suffered loss in
refining or other processing, and the
nutrients added to such foods should
preferably be the kinds and quantities
native to the class of foods involved."
* * * •
NIGHT DRIVING HAZARDS
INCREASED BY TINTED GLASS
Use of tinted glass in automobiles
or the wearing of colored glasses for
night driving is dangerous because it
causes decreased visual efficiency, in
the opinion of Dr. Paul W. Miles, St.
Louis.
"Particularly imfortunate is the pop-ular
selection of pink for the glasses
and aquamarine green for the wind-shields,"
Dr. Miles wrote in Archives
of Ophthalmology, published by the
American Medical Association. "While
pure red and pure green filters may
be quite transparent, in combination
they are opaque."
Night driving is a similar visual task
16 The Health Bulletin February, 1954
to walking into a dark movie theater,
according to Dr. Miles. When a person
first walks into a dark movie theater
there is poor visibility of the seats
until the eyes have adapted themselves
to the dark although the screen can
be seen very well.
In night driving, every change from
light, such as headlights, to dark and
from dark to light requires a new
adaptation of the eyes. This adapta-tion
process is so slow that if it occur-red
in a dark movie theater the seats
forever would remain black again black,
just as the objects at a distance or
the shadows appear on the road.
"As the driver studies the road at
the distance limits of the headlights,
he constantly tests his visual thres-holds,"
Dr. Miles said. "Objects come
into view, attract attention, and are
finally identified, as the automobile
rapidly approaches. Under threshold
conditions, an image may form on the
retina (the part of the eye receiving
the image) 50 times and be so weak
that only 25 attention responses fol-low.
Any decrement in illumination or
visual eflaciency during high-speed
night driving could delay reaction
enough to result in a serious accident.
"Modern windshields were made
green because large areas of glass let
in too much heat from the sun. A
green filter cuts out the red and in-frared
rays which carry heat. For pur-poses
of night driving this windshield
color becomes the worst possible selec-tion
because automobile headlight is
unbalanced. Almost two-thirds of head-light
energy is concentrated in the red
end of the spectrum, and only one-third
is in the range to which a green
windshield is most transparent."
Tinted glass becomes even more
dangerous at night when headlights
are turned down or when the intensity
is diminished by mud or mechanical
defect, he stated. In addition, even the
slightest tinted glass adds to the night
visual problems of color-blind persons.
Dr. Miles pointed out that tests have
shown that visual acuity is markedly
decreased by the use of tinted glass
for night driving. Normal vision is
20/20. During night driving visual
acuity is 20/32 through colorless glass,
20/34 through light yellow glass, 20/40
through pink glass, 20/46 through green
windshield glass, and 26/60 through the
combination of pink glasses and a
green windshield.
"Even more damning is the effect of
tinted glass on resolving power during
night driving," he stated. "A pair of
objects which would appear separate
at 100 feet through a clear windshield,
would appear single through a green
windshield imtil the distance had de-creased
to 25 feet.
"Green windshield glass should be
in a separate layer, to be moved aside
for night driving. Persons with defec-tive
vision, including color blindness of
the common type, should be advised to
add auxiliary headlights to their auto-mobiles
and to avoid any type of
tinted glass for night driving."
Dr. Miles is associated with the de-partment
of ophthalmology and the
Oscar Johnson Institute of the Wash-ington
University School of Medicine.
* * * *
STUDY OF RELATIONSHIP OF
NOISE TO HEALTH URGED
Study of the relationship of noise to
health, especially in industry, and an
interpretation of the findings so that
management in industry and the public
can understand them, is needed, it was
stated editorially in the Jomnal of the
American Medical Association.
Most normal persons have a wide
adaptability to noise and once adapta-tion
to a given noise level is achieved,
energy is not expended by those work-ing
in such an environment at a rate
significantly greater than normal, the
editorial pointed out, adding:
"There are many reports claiming
that noise adversely affects public
health, but the possible relationship
between noise and health needs further
study. In viev/ of the problems related
to modern industry such study is now
in order."
DR. SYDENHAM B. ALEXANDER,
UNIVER3I1Y INFIRMARY,
CHAPEL HILL, N. C.
Putli5Ke(lI)vTflEMr/iamMSIMt)°AIi])^.qEALTA
1 TKis Buiieiin will be seni free to ^
WILSON CITY AND COUNTY HEALTH CENTER
WILSON, NORTH CAROLINA
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
G. G. Dixon, M.D., President Ayden
Hubert B. Haywood, M.D.. Vice-President Raleigh
H. Lee Large, M.D Rocky Mount
John R. Bender, M.D Winston-Salem
Ben J. LavsTence, MJ) Raleigh
A. C. Current, D.D.S Gastonia
H. C. Lutz, Ph.G Hickory
Geo. Curtis Crump, MJD Ashevllle
Mrs. J. E. Latta HUlsboro, Rt. 1
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H., State Health Officer
John H. Hamilton, M.D., Assistant State Health Officer and Director
State Laboratorj' of* Hygiene
C. C. Applewhite, M.D., Director Local Health Division
Ernest A. Branch, D.D.S., Director of Oral Hygiene Division
A. H. Elliot, M.D., Director Personal Health Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
Fred T. Foard, M.D.. Director Epidemiology Division
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin, which will
be sent free to any citizen requesting it. The Board also has available for
distribution without charge special literature on the following subjects. Ask
for any in which you may be Interested.
Diphtheria
Flies
Hookworm Disease
InfantUe Paralysis
Influenza
Malaria
Measles
Scarlet Fever
Teeth
Typhoid Fever
Tjrphus Fever
Venereal Diseases
Residential Sewage
Disposal Plants
Sanitary Privies
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent free to
any citizen of the State on request to the State Board of Health, Raleigh, N. C.
Prenatal Care
Prenatal Letters (series of nine)
monthly letters)
The Expectant Mother
Infant Care
The Prevention of InfantUe Diarrhea
Breast Feedlnpr
Table of Heights and Weights
Baby's Daily Schedule
First Four Months
Five and Six Months
Seven and Eight Months
Nine Months to One Year
One to Two Years
Two to Six Years
Instructions for North Carolina
Midwlves
Your Child From One to Six
Your Child From Six to Twelve
Guiding the Adolescent
CONTENTS Page
Accidents As A Health Problem In North Carolina 3
What To Do During Mental Health Week 5
Notes And Comment 9
T^ST ^^ mm iBllPUBLISAED BYTAE N^A CAROLINA STATE BOARD-^AEALTA
Vol. 69 MARCH, 1954 No. 3
r. W. R. NORTON, M.D., M.P.H., State Health OflScer JOHN H. HAMILTON, M.D., Editor
ACCIDENTS AS A HEALTH PROBLEM
IN NORTH CAROLINA
By CHARLES M. CAMERON JR., M.D., M.P.H.
Chief, Accident Prevention Section
N. C. State Board of Health
A widely circulated standard Ameri-can
dictionary has defined an accident
as "an event that takes place without
one's foresight or expectation," how-ever,
experience has alerted health
workers to expect accidents to cause
over 2400 deaths in North Carolina
each year and to cause an estimated
240,000 persons to be permanently or
temporarily disabled.
While the accident to the individual
may be classed as an unexpected event,
the accident toU in the community may
be predicted with alarming accuracy
in terms of deaths, disability and eco-nomic
loss. Numerically, accidents are
ranked as the fourth leading cause of
death in North CaroUna and since
accidents claim their victims at an
earlier age than heart disease and
cancer, it is now considered by many
as the most important cause of death
from the standpoint of economic loss
to the state.
Credit for creating awareness to the
accident problem must go to those
active in the field of occupational
health for it was in this area that
the first steps were taken into the
reasearch, study, and action in making
the individual safety conscious .
With the advance of the motor ve-hicle,
much attention has been directed
toward accidents related to transpor-tation
and many agencies are now en-gaged
in full-time activities designed
to reduce the number of lives lost
on America's highways. Until the past
few years, little effort has been ex-pended
toward the prevention of the
accident in the home and on the farm,
an equally serious health problem which
was recognized by a few far-sighted
pubUc health workers as early as 20
to 30 years ago.
In North Carolina in 1952, all acci-dents
caused 2,492 deaths. Of this nimi-ber,
1,168 were associated with some
type of motor vehicle accident and
168 were caused by some other form
of transport vehicle. A total of 1,158
accidents were classed as non-trans-port
accidents. Of this latter niunber,
the largest single group, 618 fatal acci-dents,
occurred in the homes or farms
of the state. The remaining 540 deaths
were caused by accidents in public
parks, playgrounds, fields and woods
and other areas outside the home.
OflBcial records are available only
on fatal accidents, but the National
Safety Council, using figures obtained
from large scale household surveys,
estimates that for each fatal accident
there are from 100 to 150 non-fatal
accidents which result in disabiUty for
at least 24-hours. It is also estimated
that for each fatality, there will occur
The Health Bulletin March, 1954
four accidents which result in perma-nent
disability of some type.
Using the number of fatal home
accidents only as a base, then it be-comes
obvious that there were 60,000
home accidents in North Carolina
which disabled for at least 24-hours
and that North Carolinians were dis-abled
permanently at the rate of 2400
per year from home accidents in 1952.
Two other figures are available wliich
may help define the accident problem
in North Carolina. The North Caro-lina
Blind Commission has estimated
that about 19 per cent of their clients
are blinded due to accidents. The
Vocational Rehabilitation Division of
the Department of Public Instruction
has stated that accidents are the larg-est
single cause for referral to their
agency, accoimting for 25 per cent of
all injuries in which rehabilitative
services are rendered.
Due to the large number of organi-zations—
both public and private—who
are active in the health field, many of
whom moblize tremendous public re-lations
programs to obtain public sup-port,
it is difficult at times to obtain
an unbiased accoimting of the serious-ness
of any given condition as a health
problem. One should be aware that
home accidents in North Carolina in
1952 caused more deaths than did
poliomyelitis, tuberculosis, diptheria,
and the other major commmiicable
diseases combined.
The home accident is the only single
cause of death which ranks among the
leading seven causes of death for all
age groups. It is a leading cause of
death during the period from birth
through young adulthood and while
the home accident ranks as a lesser
cause of death in the older age groups,
the actual numbers of accidental deaths
remain large, but become only re-latively
less important as the incidence
degenerative diseases increases with
advancing years.
During the past two years, the local
health departments in the state have
cooperated with the N. C. State Board
of Health in the collection of epi-demiological
data related to fatal home
accidents. Health department staff
members have conducted on-the-spot
investigations into the circumstances
smrrounding home accidents which
terminate fatally. This data is now
being subjected to statistical analysis
and certain preliminary information
has been developed.
The North Carolina studies have re-vealed
that accidents are the greatest
threat to the very young and the very
old with 20 per cent of non-motor
vehicle accidents occuring to persons
under five years of age and 20 per
cent to persons over 65 years of age.
Falls, of all types both on the level
floor or ground, and from one level
to another as in the case of steps,
porches, and ladders, were the single
most important type of home acci-dents.
Falls caused 278 deaths in the
home in 1952. Over 60 per cent of
fall victiQis were over 65-years of age.
Fires, explosions, and conflagrations
were the second most frequent type of
home accident, causing 202 deaths.
About 40% of individuals killed by
fire in the home were under 10 years
of age and an additional 17 per cent
were over 65 years of age.
Accidents with firearms caused 65
deaths in 1952 and about 20% of these
deaths were in children under 10-years
of age. The "imloaded gim" remains a
serious menace in many North Caro-lina
homes. Poisons, both liquid and
solid, ranked as another important
cause of death in the home, accounting
for 41 deaths, over 50 per cent of
which occurred in children under 5
years of age.
If accidents are classed as "motor
vehicle" and non-motor vehicle," one
finds 1292 accidents in the latter cata-gory
in this state in 1952. A total of
903 of these accidents happened to
men while the weaker sex accounted
for 389 accidental deaths. The acci-dent
experience is higher for men in
every age group except the years above
65-years when more females were
killed than males. The calculation of
age-specific death rates which will be
included in the final tabvilatlon of
the 1952 data may show this differ-
March, 1954 The Health Bulletin
ence is not a true one.
Additional information relating to the
accident problem is now being develop-ed
and it is planned to make this
information available to interested
groups and individuals in the state as
the accident studies continue.
It is obvious that accident's repre-sent
one of the most serious health
problems facing the state today. From
the close relationship which pubUc
health departments enjoy with the
individual and his home environment,
it seems obvious that the prevention
of home accidents warrants the speci-fic
attention of the State Board of
Health and the local health depart-ments
in North Carolina. Important
in this connection is the fact that
public health workers are trained in
the fundamentals of disease preven-tion
and should be able to adapt these
principles to accident prevention.
The prevention of home accidents
has been categorized by public health
specialists as essentially a local health
department activity. The State Board
of Health can offer consultation and
assistance in planning an accident pre-vention
program, but the actual work
must be carried out at the local leveL
No one professional group in a health
department can be designated as solely
responsible for the accident control
activities. This activity must be re-garded
as a public health problem
requiring the efforts and cooperation
of every staff member. Such a program
to succeed must embrace the medical,
nursing, sanitation, statistical, educa-tional,
and other health department
personneL
The U. S. Public Health Service, a
health agency which has been active
in the field of accident prevention
for the past several years, has defined
the immediate objectives of health de-partment
workers as the elimination
from the home, so far as possible,
those conditions which cause accidents,
and the training of people to act in a
safe manner within the home environ-ment.
The very nature of the health
department's work with all ages and
all groups makes each staff member a
potentially potent force in the preven-tion
of home accidents.
WHAT TO DO DURING MENTAL HEALTH WEEK
By EDWARD S. HASWELL
Chief, Mental Health Section
State Board of Health, Raleigh, N. C.
Take a good look at your calendar.
Have you marked off the first week
of May—May 2-7? If not, do so—in
red too. For that is an important week
for you—the most important, I think.
It is MENTAL HEALTH WEEK.
You may disagree with me about
this. You say, "Why should I be bother-ed
about MENTAL HEALTH WEEK?
There's nothing wrong with my mind."
And, no doubt, you are right.
Probably you are physically healthy
too. But does that mean you will al-ways
stay that way? No necessarily.
For you know that you can still get
many different sicknesses and ailments.
Because of that, even though you do
enjoy good physical health, you are
concerned about it.
Probably you do evers^thing possible
to keep healthy. You eat the right food,
drink pasteiurized milk, get fresh air,
a certain amount of sleep, brush yoiu:
teeth, and, of course, you don't eat
spoiled food or drink impure water.
And if you do have an ache, a pain,
or a fever, you go to your doctor.
Well, that's the way it Is with your
mental heaJth. Just because you have
good mental health, doesn't mean you
will always have it. For you can get
all kinds of mental and emotional
6 The Health Bulletin March, 1954
sicknesses, the same as you can get
different physical ailments. So you see,
you should be concerned about your
mental health.
But, keeping mentally healthy, is not
altogether easy. For one thing, few
communities have mental health spe-cialists
to suggest ways of staying men-tally
healthy; few communities have
mental health specialists who can
help you regain your mental health if
you should begin to lose it. For frankly,
when it comes to North Carolina, it
just does not have enough mental
health specialists or facilities to give
you and yoiu: children and relatives
the best possible help when it comes
to mental health.
Yet, North Carolina does not have
to continue to go without these facili-ties.
You can do something about
changing this situation. So can your
relatives, your friends, your neighbors.
As a matter of fact that is why
MENTAL HEALTH WEEK should be
especially important to you. It gives
you a chance to do something about
North Carolina's inadequate Mental
Health facilities.
FOR MENTAL HEALTH WEEK is
not just a time for reading articles
or listening to radio programs and
speeches about Mental Health. It is
also a time for you to ask some
searching questions about your com-munity's
mental health facilities. For
instance, you might ask, "Could my
commmiity give help to someone like
Jim?"
Frankly, Jim is no one in particular.
He could be your doctor's, or minister's,
or teacher's, or neighbor's boy. He could
be yours. For Jim Is everywhere—in
every commiuiity. There are thousands
of Jims.
Probably he attends your local school,
though he isn't too happy about it.
No doubt, he plays hooky—probably
started truanting when he was rine
or ten years old. He's been in all kinds
of mischief too—stole a bicycle and
broke into a store. In so many words,
Jim is a delinquent.
That means something must be
wrong with him—he must be malad-justed
som